We talk to Jim Watts, Consultant in Critical Care Medicine and Anaesthesia and JAP’s consultant editor.
JAP: As a specialist in anaesthesia, could you tell us more about your experience and training background in this field?
JW: I trained as an anaesthetist in the days when critical care was not a separate specialty, in both the North West and the West Midlands. I took up my SR post the month before they changed to run through ST training, so I can claim to be one of the last of the Senior Registrars.
My non anaesthetic training consisted of House Officer posts in Wales, and the North West; and SHO posts in paediatrics and casualty.
Even as a trainee I looked for extra curricular roles that not only stimulated my interest but which boosted career prospects. I was one of the youngest doctors recommended for a faculty position in the then fledgling ALS/APLS training, and I also held a post on the Group of Anaesthetists in Training (GAT), which meant that I became a co-opted member of the Royal College Training committee. Both of these experiences fostered an interest in teaching and training that has lasted all of my career. As a consultant, I have taken on a number of additional roles including Clinical Director, Deputy Medical Director, an advisor to NICE, Medical Examiner and I was previously an advisor to the PHSO. This has given me a broader understanding as to how the NHS works as an institution, locally, regionally and nationally.
JAP: What drove you to choose anaesthesia as a career?
JW: When I completed my House Officer years I was somewhat disillusioned with the way medicine was practiced on the wards, and I knew that I was not suited to be a GP. So I was looking for a career that was patient facing, that did not place me at the mercy of random and unjustified recurrent calls, but which would allow me to develop my diagnostic and technical skills. In those days, it was legitimate to sign up to a year’s worth of anaesthetic practice, at the end of which you could sit the Diploma in Anaesthesia –now known as the part 1 exam. Within days, I knew I had made a great choice. This was the ‘real-time’ specialty I had been looking for, which would give me the breadth and depth of practice that would allow me to develop my clinical acumen, and to learn new technical skills.
Anaesthetists remain the most skilled generalist in the hospital, very experienced at an early stage in their career at recognising and treating the seriously ill, while retaining a high level of appropriate hands-on consultant supervision. In addition, the challenge of critical care remained fascinating: a related, but different set of skills to optimise the treatment of the chronically critically ill
JAP: As we head in 2021, it is clear that the healthcare industry has been greatly impacted by this year’s events, what has been the greatest impact within the anaesthesia industry?
JW: I think the need to develop CPAP/Nasal high flow/ CPAP as a ward based therapy, which means finding the equipment (hopefully now in plentiful supply) and addressing training issues in nursing and medical staff, and developing ward based facilities.
We have also seen an unprecedented expansion in Critical Care facilities, and hopefully this extra bed base will be maintained, funded and supported to enable us to accommodate more complex surgery and unwell patients.
The main lesson of 2020 though is that we have been reminded what a world without antibiotics looked and felt like. We forget that antibiotics have only been around for a relatively short period, and that microorganisms are becoming increasingly ineffective. Hopefully there will be an increasing focus on correct antibiotic stewardship, and a recognition that this is the responsibility of everyone: medical and nursing staff, politicians, agriculture and vetinary medicine.
JAP: What’s the best part of your job?
JW: The best part of an anaesthetist’s job is being able to provide a quality experience to a patient from the start to the finish of their surgical journey.
There is no such thing as just a “quick GA”. Every anaesthetic is a risk, and every technique must be individualised to the patient. Whether it is for a day case procedure, or lengthy complex cancer surgery, being able to ensure that the patient emerges in the best condition-oxygenating, pain free, physiologically stable-to give them the best chance to benefit from the surgery is the best feeling.
It is similar in ITU: our role is to achieve physiological stability giving the patient the best chance to get better from their underlying pathology. As a bonus, you can sometimes address other problems that the patient has acquired, such as social issues or chronic pain.
JAP: … and the worst?
JW: The number of people who believe they can tell me what my job is, or the belief that my ability to sort out a difficult situation is in some way approval of what has gone before.
JAP: What has been the highlight of your career so far?
JW: So many highlights, but being able to redesign and modernise an ITU with a team of managers, nurses and medical colleagues in my first few years as a consultant has to be in the top five. In a way, the COVID epidemic has also reintroduced the concept of teamwork, and focused us on wellbeing of the whole staff as important to patient care.