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Wednesday, May 29, 2013


Professional ego is commonly observed in medical profession.It is the basic nature of every human being to claim the superiority over others thinking that he is more perfect and has got additional capabilities over his fellow colleagues.Medical profession is no exception.Among the physicians ego is more common among the anaesthesiologists because the choice and techniques to anaesthetise a particular patient are diverse and are based on individual experience and expertise

Several techniques and methods are possible to anaesthetise  a particular patient or to perform a particular procedure, (with the procedural advantages or complications specific to each of them) Often there will be debate on which technique is superior or suitable to the procedure.Individual experience may favour one to go for a particular procedure which may be deferred by others. Often the senior fellow or consultant will win in this argument as he is more powerful to execute his commands. In such instances it was advised to follow standard protocols or evidence based techniques,or majority opinion.Healthy discussions based on standard literature will help the clinicians to formulate an action plan and to proceed, which may help in their professional and academic improvement.

If the consultant is not successful with the procedure he proposed and that too witnessed by  his colleagues he may feel ashamed but  he may declare that the procedure is difficult but his ego does not permit him to allow his juniors to repeat the procedure and he may go for an alternate procedure.As a result the patient may suffer as he is not able enjoy the advantage of that particular procedure.This is true when epidural anaesthesia is to be performed for a hypertensive patient or PIH patient where a change in hands may make the procedure less difficult and often successful and the patient is gaining the benefit of regional anaesthesia over GA.

The procedural ego unveils especially when somebody fails to perform upto their self expectations.The physician will be tensed and nervous and keep on trying. During unsuccessful intubation he may not hand over the case to his fellow and instead keep on trying, introducing trauma and making the airway more difficult for others to manage.I have observed a specialist attempting  more than 8 times to insert a spinal needle in an obstetric patiebnt for caesarean, while the consultant observing this is advising him repeatedly to abandon the procedure and go for GA. The specialist was not giving ears as he thought, failing the procedure in front of staff  and gynaecologists may affect his reputation badly.This patient suffered severe post spinal head ache with nystagmus and vomiting for several days post op.You may also find some instances in regional anaesthesia procedures where the junior kept on praying that his senior should fail because he has already failed to perform. He is seen depressed and withdrawn the whole day because the senior was successful in single attempt.

Ego with investigations,was also observed  among a few anaesthetists, when they delete or modify some of the preoperative investigations ordered by surgeons.The anaesthetist may ask for a fresh set of investigations just because the previous tests were ordered by a surgeon. This is because many feel interpreting investigations ordered by other doctors is an inferior job but they are not aware of the financial burden, physical strain and pain involved in repeating the lab tests.

Ego with paramedics and nursing staff, needs to be mentioned.The physician's ego doesn't permit him to accept minor mistakes by him, which are pointed out by nursing staff or technicians.Look at this incidence, A faint pneumothorax shadow in X ray was missed by an anaesthesia specialist  but was observed by an X ray technician.The technician took the X ray and reported back to the specialist.Instead of admitting his mistake and attending the patient in ICU, the specialist filed a petition to higher authorities against the technician's rude behaviour! This is not appropriate as your ego should allow to appreciate and complement them.

Ego with patients,Here the physician fails to explain in detail about the anaesthetic procedure and about its complications.They just ask the patients a few serious questions during PAC and ask them to put their signature in the consent form.In fact they become restless and uncomfortable when the patient starts asking questions.On the contrary some physicians try to over exaggerate the complications and procedural details to make the patients feel that he will be doing something dangerous and great for patient's sake.Both of these are harmful practices as either the patient is unaware of the procedure or he will be too much nervous and tensed to face the situation.Pull out your ego and reassure the patient,explain about the possible complications, and gain the confidence and trust of patients and relatives.

It doesnt matter whether the physician is  an egoist or not,but denying treatment or harming patient's health on account of his ego, is strictly against medical ethics. One should identify his limitations and weakness as human beings and should have a helping mentality.He should be open to his colleagues, help them out in cases of difficulties, hear to them and should be willing to discuss with them.As we learn through mistakes,suppress your ego towards those who point out your mistakes. Since most of the procedures in anaesthesia are "blind techniques" patient, positional or technical variations may affect them. Luck also plays.So dont be hesitant to hand over the procedure to a senior colleague or ask your junior to try out with a different hand, when somebody fails in  few attempts.The ultimate aim of ego less practise is Safe and Quality patient care.

Ego is like your branded clothes.Its is important that you have it,but not necessary to show it always.You may have much of an ego in anesthesia because you aren't respected by the patient's relatives, you are not paid like surgeons and you have to work behind the curtains where no one understands how serious and risky is your job.But you may remember that Ego can be a great  motivator and destroyer as well.Those who are successful in life know how to control their ego.No one is superior to others and the medical law states "You know only a fraction of what you are supposed to know" and no one can learn everything in medicine.Say good bye to ego and be part of the team work for better and quality patient care through dynamic decision making and individual participation which makes the practice of anaesthesia more meaningful and sublime.

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