All over India anaesthesiologists work in three different setups, institutional, corporate & small nursing home setups. The management of patients differs in all these setups.
Types of anaesthesia practice

• Institutional
• Teaching institutes
• Charitable institutes
• Hospital based
• Corporate hospitals
• Small nursing home setups
• The approach of surgeons & anaesthesiologists do differ at these different

Types of compromises

• Institutional practice
• Accepting fitness certificate from physicians or other concerned specialists.
• Investigations of the patients may not be of anaesthesiologist’s choice
• Overcrowding of cases
• Time constraints
• Expertise of other specialists is to be accepted
• Resistance from other specialists for research work
• Selection of anaesthesia technique may be influenced by surgeons
• Procuring anaesthesia equipments is not always easy
• Has to modify technique on the basis of theatre conditions
• Recognition amongst laypeople is limited
• Limitations to practice other avenues of anaesthesiology like painless labor, intractable pain relief
• Hospital practice
• Accepting fitness certificate from physicians or other concerned specialists.
• Investigations of the patients may not be of anaesthesiologist’s choice
• Overcrowding of cases
• Time constraints
• Expertise of other specialists is to be accepted
• Resistance from other specialists for research work
• Selection of anaesthesia technique may be influenced by surgeons
• Procuring anaesthesia equipments is not always easy
• Has to modify technique on the basis of theatre conditions
• Recognition amongst laypeople is limited
• Limitations to practice other avenues of anaesthesiology like painless labor, intractable pain relief
• Monitory gains are limited
• Anaesthesia accidents are difficult to manage medically & socially.
• Irregular working hours
• Drug & equipment procuring is always a problem
• Has to leave patient without qualified post operative care
• Premedication may not be always of choice
• Modification of anaesthesia technique on pre. Intra & post operative availability of drugs, equipments & personnel.

Why anaesthesiologists have to compromise?

• Attitude of compromise
• Always tries to commit on safer side
• Reluctant to use newer modalities for the sake of savings
• Less tendency to invest
• Economical consideration always at top
• Stigma of dependency
• Can’t generate work on our own
• Unless there is pain, no work for us
• Consider surgeons as employer
• More importance given to comfort of surgeon
• Considers oneself as second-rate citizen of medical field

How we can change?

• Change the attitude
• Undergraduate education must include anaesthesia subject
• Post graduate training mindset has to change
• Most emphasis on preoperative optimization of the patient
• Pre-anaesthesia check up clinics must become preoperative optimization clinics
• Improve on perioperative care by taking periop wards under anaesthesiology
• Patient safety must dominate over economic constraints
• Coming out of stigma of dependency
• Diversify work outside OT
• Painless labor. Pain relief & intensive care by anaesthesiologists has to be promoted
• Invest your money, time & intelligence in improving anaesthesia care
• Improve awareness amongst laypeople about anaesthesiology.
• Improvement in anaesthesiologists’ fees

Changing the basic mindset of anaesthesiologists can only change the situation & many people have achieved success in this regards.