Scope of practice
Anaesthetists are generally understood as the doctors who 'put you to sleep for surgery'. Certainly this is an important part of their work, but anaesthetists, as highly trained specialists, have a scope of practice which extends beyond anaesthesia for surgery to include pain management and intensive care. Anaesthetists have a medical background to deal with many emergency situations.
Training
Anaesthetists are fully trained medical doctors and they form the largest specialty group of doctors in National Health Service hospitals. After qualifying doctors choose between many specialities for further training. Anaesthetists are doctors who have undergone postgraduate specialist training in anaesthesia, intensive care medicine and pain management.
The standards of training in the UK are high and exacting. The Royal College of Anaesthetists has duties to set the standards of the training programmes and, working with the Postgraduate Deans, it ensures the quality control of training in hospitals where the training takes place. For these new doctors training starts as an SHO (Senior House Officer) for at least two years. The trainee SHO achieves a basic level of competence, but is supervised in their work. The degree of supervision depends on their experience. After training as an SHO the trainee has to apply for, and be accepted on a specialist registrar training programme (SpR). This lasts for five years during which the trainee gains further skills and experience. Specialist registrars are also supervised by consultants.
Throughout their training anaesthetists are assessed in the workplace and they cannot progress to the next stage of training until they have satisfied their trainers and supervisors that they have reached the required and well defined standards. During the training programme, the trainee anaesthetist takes a two part examination called the Fellowship of the Royal College of Anaesthetists (FRCA). This exam is set and supervised by the Royal College of Anaesthetists. The standards are high and trainees cannot progress to the third and fifth years of training until they have passed the relevant part of the examination. Those doctors who pass can use the letters FRCA after their name.
Only trainees who have completed the whole 7-year training programme successfully, and been awarded a Certificate of Completion of Training (CCT), can have their names included in the General Medical Council’s (GMC) Specialist Register. Only specialists who have their names included on this Specialist Register can apply for consultant posts in the National Health Service in the UK.
Around your operation
'Putting you to sleep' for your operation is a simplification! Your anaesthetist puts you into a state of carefully controlled loss of consciousness so that you feel no pain and during this time your anaesthetist looks after all your bodily functions, carefully controlling them, monitoring them and adjusting them when necessary. Your anaesthetist looks after you when you cannot do this yourself. Anaesthetists have been called perioperative physicians because they provide care all around (peri) operations. The care that they provide for you during surgery can be divided into three parts.
Before your operation
Your anaesthetist will visit you in the ward, although occasionally this will happen in a pre-anaesthetic assessment clinic. If you are a day case patient it may not be until just before your operation. The anaesthetist who looks after you on the day of your operation is the one who is responsible for making the final decisions about your anaesthetic. He or she will need to understand about your general health, any medication that you are taking and any past health problems that you have had. Your anaesthetist will want to know whether you are a smoker, whether you have ever had any abnormal reactions to any drugs, if you have any allergies, and will also want to know about your teeth, whether you wear dentures or have caps or crowns, veneers or a plate. Your anaesthetist needs to know all these things so that he or she can assess the best way to look after you during this vital period. Your anaesthetist may examine your heart and lungs and may prescribe medication to calm you - premedication.
Premedication
Is the name given to medication (drugs) given to you shortly before your operation. Though many anaesthetists no longer routinely prescribe such drugs, others still do. These drugs are given as tablets, injections or oral liquids (to children), and are intended to relax you and may send you to sleep. Do not worry if you do not have a pre-med. Sometimes, especially for day case anaesthesia, premeds are not given, as they may slow recovery. If in doubt, ask.
When your anaesthetist visits you at this point, it is the best time for you to ask any questions you may have.
During your operation
Your anaesthetist will be present at all times looking after you. The specialist training that an anaesthetist has undergone allows him or her to respond to any changes in your condition and ensure that you remain stable and pain free. All your bodily functions are constantly monitored during this time by your anaesthetist working closely with the surgeon who is performing your operation. The anaesthetist is vital in providing the right conditions for safe and successful surgery to be completed.
After your operation
Your anaesthetist continues to monitor your condition carefully. You will probably be transferred to a recovery ward where specially trained nurses, under the direction of anaesthetists, look after you. The anaesthetist and the recovery nurses ensure that all the anaesthetic effects are reversed and that your body functions are monitored as you return to full consciousness. He or she will ensure that you receive the right amount of oxygen, medication for pain and any intravenous fluids that you might require.
Pain medicine
Not only are anaesthetists the specialists who ensure that you are pain free during and after the time of surgery, but because of their specialist training some are also qualified to care for other sorts of pain. Anaesthetists are the specialists who control your pain during child birth with spinal and epidural anaesthesia and occasionally general anaesthesia. They are caring for you and your baby. For more information about this, see the section Anaesthesia and Having a Baby.
Anaesthetists also care for patients with acute, chronic and cancer pain. Pain Clinics can be found in most hospitals and the anaesthetists there have undergone specialist training in many techniques to tackle and relieve these different sorts of pain. For more on this, go to the British Pain Society website.
Intensive Care Medicine
As part of their training, anaesthetists undergo specialist training in intensive care medicine, and most of the doctors in intensive care medicine are anaesthetists. Their training means that they have the medical background to deal with many emergency situations and they form vital members of resuscitation teams. On intensive care units the medical background and training of anaesthetists allows them to monitor and care for your breathing, heart rate and function, blood pressure, temperature, fluid balance, nutrition, the working of your kidneys and liver and all other bodily functions which are often compromised in patients who are seriously ill and require intensive care. More on this topic can be found on the Intensive Care Society website (public information currently in preparation).
You are likely to come across anaesthetists in other areas too such as trauma medicine. Some procedures in the radiology department such as imaging, scanning and so on require the help of the anaesthetist to ensure that you are pain free and you may be given a general anaesthetic during these procedures. You will also find anaesthetists in endoscopy units, involved in electro-convulsive therapy, in dental units and so on.
