In this episode of Doctors Getting Coffee, Dr Syl speaks with Dr Laurence Boss, an anaesthetist from St George Hospital. It was a wonderful conversation and Dr Syl loved Laurence's energy and engagement. They spoke about Laurence's time as an intern in the UK, working in air ambulance, what it was like to work in Australia compared to the UK, they spoke about burnout and what scares Laurence as an anaesthetist, and they spoke about down time and the importance of 'fads!'.
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In this episode of Doctors Getting Coffee, Dr Syl speaks with Dr Laurence Boss, an anaesthetist from St George Hospital. It was a wonderful conversation and Dr Syl loved Laurence's energy and engagement. They spoke about Laurence's time as an intern in the UK, working in air ambulance, what it was like to work in Australia compared to the UK, they spoke about burnout and what scares Laurence as an anaesthetist, and they spoke about down time and the importance of 'fads!'.
Support the channel!
Shout the next Coffee: buymeacoffee.com/DrSyl.AU
Become a Member: youtube.com/channel/UCiOBkubL46VQT9mPqrnJlrQ/join
Become a Patron: patreon.com/DrSyl
hey guys dr seal here welcome to another video today i have the absolute pleasure of speaking with dr lawrence boss an
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anaesthetist at st george hospital is it right if i call you lawrence definitely yeah great uh so um laurence and i are
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gonna have a talk today um and we're gonna talk a bit about his career and i hope you guys enjoy also before we start
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i want to say a massive thank you to colonel b who donated today's coffee through the buy me a coffee uh app i'll
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put a link down below if you want to buy the uh episodes more coffees but really appreciate that colonel b thanks
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um so uh lawrence i guess a nice good question to get started with is if you
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can give us a bit of a summary of your career uh
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it's you know it's it's interesting it's a a common interview question as in when you're going for a job
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do you do many of the interviews by the way well i had one this morning oh right yeah um and it wasn't asked they didn't
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ask you to summarize your career but it was definitely one that i had thought about mostly though i don't think people
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really want to know the ins and outs of what you did all the way through your journey but maybe the highlights or what was dear to
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you the things that i um sort of fondly remember
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um across i guess it's 20 years is starting out as a house officer in the
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uk in brighton and having a couple of mates around me all as scared as i was and i don't think
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you realize how scared you are when you start your job what you realize is when you're handing
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over to the next person a year later and you look at them and you say think you're really nervous about starting
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medicine i must have been like that and so you only generate the insight
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into i think how anxious or anxiety producing it was when you see what you were probably like
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having journeyed through that year i found that too now i'm a resident i'm a solid year into the career
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ready for retirement but and yeah just talk like working with interns for the first time like i had
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medical students as an intern but it's not the same actually having a colleague who's an intern seeing the difference and how far you've come in a year is
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pretty uh interesting so you started in brighton right yeah yeah um the gay capital of the uk oh right yeah didn't
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know that uh and one of my first jobs was actually with a um
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a urology surgeon who um did uh sex changes oh okay yeah as an intern
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that was one of your first yeah introductions to medicine yeah so i was helping to kind of manage those patients on the board and afterwards um
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uh and then i think probably the next interesting kind of part of my life was as a
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uh an anaesthetic registrar uh i found myself flying around in a little
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five-seater fixed-wing to europe picking up um [Music]
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people who had been on holiday come a cropper maybe in a trauma moped
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accident ended up in intensive care and were being repatriated by the insurance companies yes and so i would fly them i
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would fly out go in an ambulance to the hospital and fly them back to um to wherever their home town in the uk
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was and although obviously you know a cohort of patients who had
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something terrible happen to me in their lives it was so relatively rewarding to help bring them back to their loved ones
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but also you know fascinating in terms of the transfer medicine
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you would have had a good exposure to a lot of the kind of technology that anaesthetists would use right like you
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would be are these medical planes like medical transfer plants oh no but fitted out so kitted out right so you had like
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monitoring yeah yeah yeah the whole the whole um shebang yeah i they did you ever have any mid-air
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emergencies where you had to intervene on things or was it usually they were pretty stable before transfer lots of
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protocols lots of good non-technical skills amazing nursing staff that go with you and the pilots were all
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obviously very familiar with the processes so lots of safety built into the pros the process and the
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um and the journeys and you'd stop you'd land you'd have to stop off because you're carrying more weight on the way
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back than you were on the way there from the patient and a relative uh so you'd stop off in somewhere like leon in
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france and refuel and just check everything was okay and then carry on and these patients were stable so rarely
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were they uh unstable enough they couldn't go in an ambulance or go in a plane
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but the it was hard to convince the italian paramedics who would come and
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collect you from the airport that you didn't need to go blue light siren down the central reservation on the way to
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the hospital because there was no patient on board so much to the you know to the the calls of it's okay um you can
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just travel at the normal speed on a normal road straight blue light all the way down the
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central reservation which again you just had to accept when you went to these places the norm is their norm yeah you
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do what the cops want yeah yeah yeah and you don't drink coffee so i bet you that wakes you up pretty well though
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yeah that's right yeah i just never have like um i don't know whether it's i've never
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grown up um is it an english drink when you're yeah it's good it's sort of
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gathering momentum yeah tea would be the sort of classic but i don't do that either right just um just water or beer
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right but never together [Laughter] all right quick side what's your
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favorite beer um anything by willie the boatman in sydney oh yeah uh they are they're a
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nice little local brewery doing some amazing stuff and then uh in botany there's a place called one drop and they
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do a an eclectic uh mixture of beers so they're it's pretty punchy i think it's eight
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percent but their um milk their milks milk oat ipa
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yeah yeah is uh okay is fascinating yeah
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so you're doing this um light aircraft uh transfer part of your career how like
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how old are you there what what uh pgy are you equivalent are you five years out of uni at that point
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yeah probably mid registrar level so maybe five or six years
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in and three years into anaesthetic training yeah right and so that springboarded me
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on to getting an air ambulance job in sydney so i
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at the point at which i was in my final years of training we decided that we wanted a year away my
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wife and i we had two kids at this point and i got jobs in canada and in sydney
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and my wife said what's the lowest temperature that either of these two countries get to
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wise that's a good question so that we ended up in in sydney
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wow yeah and so then i worked us in george for six months uh i went back so what was your
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relationship with st george at that time professionally was a day um air ambulance did six months of our ambulance and then
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it was twinned with a six-month stint as a fellow here oh well that's great yeah so six months on ground six months in
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the air yeah that's a pretty good mix yeah yeah it was lovely it was great and we traveled in every direction is that
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you're going on by the way what this air ambulance contract i would be interested in
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yes no but there's several colleagues who um who work in the department who still do a hybrid job i've seen them
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drop off and well i don't know if it's yeah that's the same exact position but on the helicopter transfers our open
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thorough economies have been on a couple of i've been up to the helipad for a couple of those yeah as an ada yeah yeah don't
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worry i'll introduce you to rob scott who i'm sure will be your next interview great yeah yeah yeah he'd be a
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great person to talk to to talk to um and so have you been with uh st george
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ever since no so went back to the uk oh i was a consultant over there for three years had another child do your
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consultant did you become a consultant in australia then go over or you finished off your training back in the uk so okay
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and then was a consultant in the uk for three years had another child so we have three kids and then decided to make the
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jump pack over here about six years ago so i'm interested to know what it's like having kids as a as an aesthetics boss
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like how you manage work life in that regard but also how you make a decision between uk and australia with a family
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and a medical career so like how was being a father and a registrar or or a
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consultant yeah like it's busy but i think i think when you have kids and you have a career it's always busy i think
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actually it's harder for my wife than for me she's a gp uh and although i am a hands-on dad
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there's some stuff that the kids want and there's sometimes that they just want mum and invariably
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the tension is between forcing them to have me look after them versus what you
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get guys so it's a balance and what you try and do
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is see plenty of your kids and do a good job at work and hope that that meets the balance that you want yeah
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and so how do you decide whether to live in england or australia personally for you
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i i forgot to say that i did actually work in perth when i was an intern so post-intern job
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i came out to perth as a as an srmo yeah so that was my first hit of of
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australia and that's why we wanted to come back was one of the reasons that we wanted to come back as a fellow
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so i always wanted to live in australia i just liked i always wanted to live
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somewhere that other people went on holiday yes and that's what australia has definitely become isn't it we get a lot of um uk
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doctors coming over and a lot of questions um about the differences in working as a
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doctor in uk versus australia i guess you could speak from the anesthetics point of view
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have you found some pretty like obvious differences between the two systems or
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is it pretty similar no it's pretty similar oh no the the you know the machines are the same the drugs that they're saying the anaesthetic nurses
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are the same um they're all amazing better weather better weather
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there are some nuances to it so uh maybe they're sydney based as well but
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you know for example there's much less elective work in public hospitals here it's all done in the
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private sector so there's more choice over here from that side of things um the downside is that
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as a public fanistas most of our work is emergency work now i
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quite like that i find that enjoyable and interesting but if you're trained to do some
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elective work then mostly that will be found privately right uh it's and it's a balance like everything the nhs the the
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system in the uk is pretty much 90 nhs work so there isn't much in the way of private medicine and again there are
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good and bad sides of that um but over here i think it's probably
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maybe 60 40. we talked a bit about your career but i'm interested in knowing the key
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decision point for you when you decided to become an anaesthetist like why an anaesthetist why not anything else
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yeah i guess i had enjoyed everything pretty much in medicine
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so all the terms i did as a medical student i didn't want to be a cardiothoracic surgeon i kind of had made the decisions
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about some of those heavyweight sort of specialties
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but i didn't really know what i wanted to do and i hadn't ruled out gp often in med school i think general practice is
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given a a terrible kind of rep but it's yeah it's always what specialty do
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you want to do yeah and that everyone's and people don't people fall back on it's like it's a sort of
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um a failure specialty but the perception is 60 or more of medical students will
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become general practitioners and actually if i had my time again don't don't tell anyone
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if i had my time again i'd have been a gp wow because you
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get set up quickly you're in control of your own destiny
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the stuff that interests me as much as the medicine does is all the non-clinical part of this job which
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there's ample scope to do in general practice so education is a good example but you
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know managing people managing processes quality improvement projects for quality improvement work
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leadership and management all those non-clinical parts of of becoming a senior clinician there's
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ample scope for those and you can you're in control of your own destiny right you can choose the hours you work and the places you you
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you go and as a data three the non-medical time becomes
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as or more important than the time you spend at work and all the mates that are now general
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practitioners are all very happy with their lives and and pleased that they either fell into it
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were pushed into it or or you know chose to do general practice um
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however uh i did edie in perth and loved it and i
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think if i had a stayed in perth and five of my mates stayed after we all left and
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most of them became um ed physicians i think if it stayed i would have done emergency medicine it was great over in
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perth uh but i came back to an intensive care job just a standalone i guess srmo
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equivalent job and the people that covered the on calls overnight were anesthetic registrars
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and they were all uncalled for what just after the unit so the senior class all right yeah
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yeah it was it was uncoupled at that point so there wasn't an intensive care specialist
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yeah okay um so mostly it was an isis who sub-specialized in intensive care who
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then ran the units as consultants and any which way of doctor could staff the
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middle canadia but they were most mostly the senior support in ho in the hospital after
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hours were anaesthetic registrars and they were all you know nice people who love their job and were happy and
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were good good doctors and i was like i want to be like that yes and so i decided to try my
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hand at getting an anesthetic rotation and and fell into one and it's one thing to see and admire doctors
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and kind of want to emulate them and go on their path but then when you start the job it can be a bit different did
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you start anesthetics and just be like this is what i want to do even when you're a junior or was it something that
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over time you liked more and more and it was confirmed that that's what you wanted to do like was it an instant kind
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of hit or was it something that needed some time i definitely felt instantly comfortable
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in the decision that i've made but uncomfortable in knowing nothing about the specialty they're chosen it's again
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different to here where uh as an srmo you'll get exposed to the critical care
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specialties but it's a very like uh at least at st george is a very competitive srmo year yeah isn't it yeah hopefully
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that i think there's some other like other hospitals are also doing critical care yes yeah i don't know much about
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the junior system over here but certainly in the uk you go from having never been in theater to being an
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anaesthetic registrar day one having having no experience so you go back to feeling like a medical student
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where you don't know very much about the processes or or the um the way that
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people do stuff and the medicine behind it the learning curve with anaesthetics is
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pretty steep in a good way so you you get pretty proficient at giving a standard anaesthetic to a simple
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to a for a simple procedure to an uncomplicated patient pretty quickly you
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don't actually have to know very much to do that it's all practical but what i what you realize when you
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take the exams is that there are some good reasons why you do things and some bad reasons and things you shouldn't do
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and so you backfill the experience stuff with some knowledge and
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your world just opens up to the eclectic mix of recipes and
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and uh and drugs that you can use to help or hinder patients and all
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the and all the kind of like you're saying you get really proficient at the standardized safe pace like safe patient
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no comorbidities normal use case but then all the exceptional use cases is where the bosses come in
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um i guess i'm interested for you why you didn't choose ada or icu or because
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i'm interested in critical care and i i don't know which way really i've only
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done an ed term i didn't get icu this year this year so i'm like i'm going to try and do some icu and anesthetics um
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later on uh luckily i got a peds term though so that's good um but yeah how do you
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how did you make the the decision for yourself personally and what advice do you have to other junior doctors like me
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who want to kind of make a decision between the three um and is it just trial and error do you just have to try
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it all and see what clicks it's it seems like it's a it's a dirty word or dirty process these days
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you're not allowed to meander around different specialties and try on a few different coats and see if
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they fit and i think that's a real shame um they made a decision in the uk they
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being the sort of you know the powers that um that
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drive policy or or structures around recruitment and
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um sub-specialization that if you had done orthopedic surgery
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as a junior doctor for five years and then ended up being a general practitioner
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you had wasted your time that was the decision that was made and it would be
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much smarter for that person to have been funneled into general practice earlier
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the downside of that is that all that knowledge based around trauma and um you know
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soft tissue and and um hard tissue damage that they take to general practice where
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you need different people who can have different issues into skin and bone
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and and women's health or whatever it might be i i don't see that as a
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as a waste of their time i just see that as improving their skill set in a niche part of what we all need to be able to
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um do as a as a collective for example in a general practice so you know me wandering around doing a bit
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of ed and i did about a third and the icu during my anaesthetic training so
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again back in the uk in the sort of early 2000s you do a lot of intensive care and i loved it and again thought
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heavily about being an intensivist the the downside and i think that i think i keep coming back to as i sort of
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talk to people about their career decisions is a you'll love everything you do as a junior doctor because all the fun stuff
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you've got to work out whether the job that you will be trained to do is the job you want so look at a consultant
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intensivist or a consultancies or indeed a consultant ed physician and and say
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that's the kind of job that i want at the end because they're not the same as the job that you do as a junior doctor in
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those specialties and you have to be comfortable with the the boring or the the unsexy side of the specialty
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like e-day bosses they get the good stuff but they get a lot of the bed block logistics staffing i mean it's a
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it's an ed consultant that does the roster yeah that's mind-boggling to me because that's hours
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of work that really like thousands of dollars a fortnight that like of health care expenditure could be better spent
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so that's the other part part of the decision making i think is that look at the specialty you think you want
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to do look at the worst thing about that job if you can put up with that worst thing
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that specialty is for you so what's the fun stuff is the fun stuff yeah everyone loves the fun stuff but what's the worst
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thing about being an anaesthetist so i guess it's that sitting in a theater right watching a machine
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being bonging at you while you have your colleagues ferreting around in an abdomen for
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five hours if you can put up with that because the fun stuff of getting that patient safely
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asleep and getting them safely emerged and dealing with their their pain relief those portions of the anesthetic which
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are small they're the fun stuff yeah and it's the same for i don't know radiology
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feeding little wise into people's brains and putting coils up there is fun it sounds fun it's crazy yeah i'm a bit
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crazy but sitting in front of a computer screen and reporting a hundred chest x-rays
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ct's or chest x-rays in a dark room for 90 percent of your day if you can put up with that
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that's don't should be a radiologist so laurence uh i'd be interested to know what uh
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what scares you in your job because i think doctors are always seen as these brave citizens of the world working for
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new south wales health but uh you know there are some scary moments in every uh in every kind of physician and
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clinical job um so personally for you do you ever get scared have you just got
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like that kind of protocolized ability to assess any kind of chaos
21:53
no i think if you don't feel a bit of emotion probably every day
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then you probably should stop being a doctor right i think it's an emotional
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um profession and your human beings feed off other people's emotions you see that in kids
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and um and mostly patients have some emotions floating around when you see
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them so i think if you don't have lots of different emotions during a day
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maybe you should take a holiday or think about another career um so and and yeah
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medicine is scary because it's all the gray right it's not black and white mostly there's some easier bits to the
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day and there are some harder bits but i was just talking to a colleague earlier who is going up to theater to an
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easter eye is a 90 year old patient for a carotid stent i mean that's going to fill anyone with anxiety even if you're
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the person who helps anesthetize people for crotis sense every day so
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i think there's uh there's always apprehension especially
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if there is uncertainty and i think medicine is full of uncertainty i think that's why often people
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find it a hard specialty is if they're not comfortable dealing with a bit of
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uncertainty and you've got to um compartmentalize it to some degree and
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sometimes you have to make decisions where you've got to remove some of the emotion from those processes and that's
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where you know cognitive aids and training and protocols can help
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but if you forget that there is a patient another human being at the center of all this then yeah as i say
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you're probably in the wrong job when was the last time you felt that kind of fear like have you had any
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probably yesterday i'm just trying uh well yesterday i um i was running the
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the floor so i was the duty anesthetist and yeah what does that mean for um does
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that mean you're in charge of all the theaters as a kind of outside work and the the um the staffing of inside so you
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make sure things are running smoothly um and more and more our job as a niece this is sort of
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being pushed out of theater and pulled into the other critical care area arenas um
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lots of anaesthetics now get given um in satellite areas like mri and ct
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and cath lab but we also go down to edie and help with some of the sick patients who either
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need support down there or indeed need to come to theater and there were a couple of those patients yesterday
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the nice thing one of the nice things that has come out of covid i think if there can be nice things
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is that different silos of subspecialty have
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come together and are more used to interacting with each other so my relationships with
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my colleagues in ed are much stronger because of the need to address the pandemic
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same with intensive care so i think our jobs in general are made easier by
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having lines of communication and relationships with people in those other areas and so
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my job was made very much more easy yesterday because i knew lots of people down there you know who to talk to yeah
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before you were talking about how if you don't feel emotion you know you're probably burnt out uh
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have you ever like suffered from burnout in your career or had colleagues or close friends who've been burnt out and
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how did you kind of resolve that if it was resolved yeah like a little bit of of both right you definitely see
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colleagues and there's some support i i think burnout is the sort of the extreme that we people often talk about extremes
25:38
of whether it be health or mental health or physical health but
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actually it's all a continuum right so some days you feel more stressed than others and some days you feel more
25:50
saturated and i think it's about managing that it's the sort of small things on sort of
25:56
daily or weekly basis i definitely felt under the pump at the end of my anaesthetic training which is
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one of the reasons we came over to sydney for a fellowship abroad is to have a bit of down time with two kids i
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was commuting um sort of an hour each way with young kids
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uh and then but then we went back to the uk to finish off and i was a consultant my
26:20
before we came to australia the forever move um [Music]
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i was commuting two and a half hours each way for three out for three years
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you did it you sorry you did five hours of travel a day for three years four days a week
26:37
wow yeah you must love that job and it was a great job and i had a great
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family life and so the balance was that i had something terrible that i had to kind of do it every day but i had some
26:49
good out of it and that's the balance i didn't want to do anyone else who has to do that kind of travel now there is a
26:55
podcast which we can listen to for that long drive but it's it's if
27:00
it's if it's something where you can see the end inside yeah yeah and there's other things that keep you afloat whether
27:06
that's your friends or your family or your um hobbies and i'm a big believer in hobbies
27:13
um i take my fads very seriously ah the things that you kind of do that
27:19
overall i am i'm all i'm used to skateboarding
27:25
so tell us what do you do when you're not working um i what are your fads
27:30
i um in between beer tasting was one well beer making oh
27:36
so i i make bread and bake bread and brew beer they're currently the two passions
27:43
so what um okay because making bread is hard i've i've bought a thing off cogan and tried it for a month right yeah um
27:51
but do you make like a good sourdough is that what yeah so currently make plenty of sourdough probably six
27:56
loaves a week wow to feed the kids and the kids uh are always just hankering after um tasteless square white bread
28:05
and that's what they want three hours of eating everything and they don't want to taste they want them
28:10
wonder why not the 36 hour sourdough that i've lovingly prepared for them um you must wonder why
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uh so and again it's like anything it's about the journey i like the process i
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like getting better at something and so bread i've been doing now for 13 years and i'm pretty happy with the product
28:30
but it's different every time and it takes some time you have to invest some
28:35
energy in it and and it's always i'm hopefully always improving it's the same in medicine
28:43
and actually in anything in life i think if you want to commit to something you'll have seen it with your videos
28:48
yeah yeah exactly it is this has been a really fun um fad to kind of
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uh get slowly better and better and use better equipment and learn about all that equipment to kind of deliver
29:00
messages more efficiently and um beautifully i want it to be a very aesthetic thing as well and another by
29:06
the way a new lens this is a new lens on me
29:12
[Laughter] and i think i think the
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um i think we as human beings not only do we want to keep improving but also connections
29:24
and one of the things i think you do is try to connect with people whether it be one-on-one with the people you're
29:30
interviewing but also with the audience you're the medical students that are listening in
29:35
and i think bread baking bread is a great way to connect with people i bring it to work you know
29:41
it's one of the you know base elements of every meal every time french right
29:46
that's my background wow without good bread without french food yeah and and baguettes you know that classically have
29:52
you tried baguettes yeah yeah yeah harder easier than sourdough different entirely a different technique
29:59
the golden age of french baking happened when there was a symbiosis of sourdough
30:06
starters and commercial yeast when the two were married together
30:11
it made amazing french bread and that's what it is of this is this like maybe sort of turn of the last century
30:18
oh okay 1900 something like that so essentially people used to bake with sourdough it
30:23
takes a long time but produces a great product sometimes a bit heavier than you'd like
30:29
but you forgot that for the flavor commercial yeast comes along and you get massive instant rice so quick turnaround
30:37
very airy bread but doesn't taste very good and in france there was this big kind of uh
30:43
um you know cultural clash yeah yeah right i'm not surprised yeah we don't want the new thing no
30:49
that's a terrible idea but when people started to use both together
30:54
yeah they made amazing yeah right and that's what they got when the golden age of french baking was was
31:00
at its sort of peak wow thank you for sharing that yeah i love asking this question it's only
31:06
something i've thought about recently uh and it's what would you do if you made 10 million dollars
31:11
and i feel like it gives you an insight into whether people uh like their job
31:17
basically um so what would you do if you like honest if you really put yourself in the position like
31:23
if i gave you a million bucks a 10 million buck a million dollars doesn't get you anything no no i used to ask
31:29
that question but everyone was like i'd keep working because i have to yeah what would you honestly do if you if you made
31:35
10 million bucks and you could retire uh
31:41
10 million is an interesting number because it's it's i think we've i've spent some time thinking about this with
31:47
friends obviously over beer yeah 10 million is the point at which the money that you earned
31:54
from the interest yes is enough to live on absolutely it's 200 grand a year if
31:59
you have the right etf or whatever yeah so you could never touch the 10 million
32:04
yeah and it would turn over your enough income to live yeah so that's an interesting one that it's just on that
32:10
borderline i still need to fill my time yeah exactly do you know if i if if someone
32:16
there's only so much bread you can pay well you say that but it's 90 loaves
32:21
90 loaves is the point at which you need to break even in a bakery oh so if you
32:26
can bake over 90 loaves a day you're breaking even in a bakery a lot of loaves a small bakery yeah
32:33
um so i think if if anesthetics didn't exist i'd open boss bread and beer
32:41
that's a brilliant idea but but because um anesthetics does exist
32:47
i would still be i would still do some anesthetics because i love it i would just pick the list that i did
32:54
you'd have a customer nine yeah i'd probably go for ten of those ninety five per day but but yeah i
33:00
think i would love to i would love to own a bakery the downside is that you end up i think when you move a
33:07
passion hobby to something that has monetary kind of value to you or to other people or that
33:14
you're dependent on it becomes a job right exactly that's why i like the idea of multiple
33:19
hobbies like i don't i don't depend on youtube to survive yeah and i i guess i
33:24
do depend on medicine to survive but thank goodness i absolutely love it yeah uh it's it's a wonderful career yeah oh
33:30
thanks bread and beer that's fantastic it's really bad but you'd probably end up not i will share it when it opens not
33:36
baking the bread that you'd end up employing someone to bake the bread but maybe that would be nice if you train
33:41
them it's like intubating how often do you incubate now you got the youngest is less so less time you're
33:47
less poking around although sometimes i will um load the with if i'm working with a senior fellow if we're doing a
33:53
complex case upstairs and i will load the question to make them offer me the central line
34:01
oh what do you mean so i don't get to do any of these fun things anymore yeah yeah yeah and so i'll often say oh when
34:06
was the last time you did a central you put a central one in and they say oh last week oh i haven't done one for three months is that if i just and then
34:14
they'll say oh you should do it today i'm like you sure sure and then they'll let me so yeah i i
34:21
do sneak the odd procedure in when i can and it's good to keep your hand in absolutely because is it is it like
34:26
riding a bike or like if you a central line by the way for medical students listening in is when you want to get
34:32
access that's much better than a you know a cannula in in the forearm it's it's a big vein usually the
34:39
internal jugular sometimes other ones but usually the internal jugular you need an ultrasound you get a guidewire
34:44
and you put in a bloody big big tube in and and that gives you heaps of access for big fluids or really
34:51
quick administration of drugs to the heart uh and the rest of the body um so sometimes yeah as you're saying you try
34:58
and get your hand in to do it um and i've totally forgotten what i asked the balance between you doing it or
35:04
training other people to do it yeah yeah yeah so i um oh no if it's like a if it's like
35:10
riding a bicycle like now you've you've probably done a lot of central lines in your time but if you haven't done it for
35:16
three months for example can you just do it naturally or do you try and just review some um how to like to get the
35:24
protocol and process in order i think that any skill that you don't do very
35:29
commonly there is decrement right there you you will lose some of those just small
35:36
motor um kind of nuances to the process and i think you definitely want to keep those
35:43
skill sets up there are different ways of doing that and one of them is just to do the procedure but watching people do
35:50
procedures teaches you quite a lot about as an active observer yeah which is a big thing i tell medical students
35:55
because there's two forms of agreed being present in a ward round as the active and the passive um and the way
36:02
that you can make yourself be an active observer is you have to prepare three questions while you're observing and if
36:08
you're looking at something being done with the expectation that you will have to ask three questions so i always ask medical
36:14
students you have to ask me a question at the end of whatever we do in your exam and so you're looking in with the
36:19
frame of mind that you have to ask a question so you have to find out what you don't understand about what's happening in front of you
36:24
and that kind of switches you on yeah fantastic well i think there was one last question and then um
36:31
oh here we are question 10 this is a good one what is your favorite anesthetic drug
36:36
and why and the other way to ask this question which someone else told me today to ask is what anesthetic drug
36:41
would you be and why all right so you can pick however you want to answer that you're not rock uranium i'm not i'm not
36:50
not bored look the um
36:57
it would be hard for people for a nieces not to choose propofol wow because it's the probably the number one
37:04
drug that we would give for a general anaesthetic it's a hypnotic that is
37:09
milky white that as i say i reckon probably 99 of general anesthesia is
37:17
induced in that way and i reckon wow
37:22
general anaesthetics probably we don't give it to the very sick
37:28
or use it judiciously and some patients don't get a
37:33
an intravenous induction they maybe get a gas induction so pediatric patients of
37:39
a certain age may well get just breathe the gases down without propofol although i can bet yeah most of pediatric kinesis
37:45
would end up giving profile at some point during their case um and it was brought at around the same
37:51
time as laryngeal mask airways so it was a marriage made in heaven because
37:56
profile is great at relaxing your laryngeal muscles and lma sit in that area and so when the two came out
38:02
together if they hadn't come out at the same time we would probably still be using tubes and fire penton but because they
38:10
came out about the same time and they were perfectly matched we ended up with profile as a sort of number one drug
38:16
and i think um it's still probably quite hard to beat i don't think anyone's really surpassed in terms of hypnotic
38:23
there are some fancy drugs out there that people are now sort of starting to use for sedation ketamines in vogue
38:29
ketamine is very in vogue in ed it's not a general anaesthetic yeah yeah it is it is it is
38:34
hypnotic yeah so out in the hems world they would use it as the hypnotic agent
38:40
yeah um but you know there's the other part of me thinks that something like
38:45
remy fentanyl would be would be a good drug to be you know a drug that you can give
38:51
that keeps patients awake but they forget to breathe
38:56
now that's a cool drug that's very strange isn't it and i just remind you i'd be like take a deep breath for me
39:02
and they would take a deep breath wake up and take a deep breath yeah that's a cool drug yeah we'll have to look into the mechanisms
39:09
of action of remy fentanyl later i have forgotten that one lawrence thank you so much for spending
39:14
uh the hour with me and with everyone um it's been really really enjoyable and i really appreciate it pleasure am i
39:20
supposed to ask you a question no oh i listen to three questions oh sure i'm supposed to
39:26
i'm supposed to hold three questions if i'm going to be actively part of this
39:31
oh yeah well i asked you one at the beginning yes i'd love to hear your thoughts on that so
39:38
the question you asked me at the start was what have i learned doing these um podcasts uh talking to senior clinicians
39:46
and i do try to tend i tend to go towards personal questions to because that's what i'm more interested in
39:51
because i it's what i'm interested in and it's also what's not exposed to medical students yeah like
39:57
it's very hard for a medical student to spend this amount of time with a consultant and hence why this is valuable and human beings
40:03
learn or or gain insight from stories right stories are how we've emotional
40:11
information to other people and you hear that corridor chat did you hear about this case that i had
40:17
and often it's twinned with emotion i find that with the learning conversations you start with emotional questions
40:23
because it's how people are feeling that is important in how they're gonna yeah and so if i'm teaching medical students i
40:30
always say this is how a patient dies i go right to like this is how they die and then i work backwards from that so
40:35
how do we stop that and that so they're very eyes open and then go back what have i learned uh
40:42
i think i've learned not to rush too much um i've spoken to a couple of i i i i've
40:49
spoken to a couple of big bosses who when they say if they had their time again they might have not
40:54
um and sometimes it's off the record uh but they might not have like uh
41:01
gone so gung-ho so early in life on that specialty so quickly and
41:07
um which is it it's it's interesting because i kind of i'm keen to get get
41:13
into a training prayer and get cracking but i think it's a good reminder that the way that medicine is going we're
41:19
going to live till 900 pretty standardized and we'll probably have a
41:24
good health span so we're working much later i i expect i'll be working into my 80s
41:30
by 2070 or whatever it is i'll you know still be working fit so so what's the rush right
41:36
like don't sacrifice having a balanced view so i like i would like to do a lot um
41:44
uh you know i want to try locoming i want to try doing all sorts of things but yeah that's kind of the key thing
41:50
like what's the rush and that's made me think a bit more as like
41:55
being a well-rounded doctor is really important and my kind of goal in medicine like if
42:01
people ask me why do i want to get into critical care my goal is that if a patient dies under
42:07
my care i can say they had the best chance of survival i want to be able to say that and feel it emotionally
42:13
and right now i totally can't i can say i got the right person that's
42:18
my my job right now as a junior is getting the right person to see the patient and keeping them alive long enough to get the right person in in the
42:25
room um so yeah that's that's kind of my my goal
42:30
and that's what i've learned uh from these from these interviews i think people underestimate how much of a skill
42:36
set they have there are some overconfident doctors out there but i think actually
42:42
um i felt along the way mostly i was trained well mostly medical student medical school
42:49
did prepare me mostly my anaesthetic training did prepare me
42:54
so that i had enough of a skill set to transition to the next point
43:00
i feel like medicine probably in this country and indeed in the uk
43:05
is has worked it out enough that you get trained well enough to do the job that
43:12
you either want to do or what we intended to do it's incredible they can do it like just medicine medical
43:17
education as an as a thing is so difficult to standardize it and they've i and i agree i feel like
43:25
equipped enough to do the job that i mean um but uh yeah i also spend a lot of time
43:30
on podcasts there's some good anesthetic ones yeah yeah yes actually a lot of the registrars will swear by yeah some some
43:36
pretty good ones great well thank you so much again laurence i'll see you all in the next
43:42
episode thank you so much for staying tuned till now if you haven't yet please consider leaving the video a like that's
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subscribing all right have a good day and i'll see you in the next video