By: 23 February 2021
Anaesthetist in focus – Dr Puja Shah

As two new partners join the team, strengthening the physician team at DISC Sports & Spine Centre in California (DISC). Dr Neel P Shah is an orthopaedic spine surgeon specialising in minimally invasive surgery, and Dr Puja Shah is an anaesthetist interventional pain management specialist with a holistic focus on wellness. Husband and wife, they share a fierce dedication to individualised patient care, one they will continue to hone under the vision of DISC founding director, Dr Robert S Bray. Here, we chat to Dr Puja Shah about her work in anaesthetics.


JAP: As a specialist in anaesthesia, could you tell us more about your experience and training background in this field?

PS: The process to become an anaesthetist, especially in the United States, is quite long and arduous. However, as cliché as it may sound, it is a journey that has made us the physicians that we are. The process for me started in high school. Knowing I wanted to be a physician, I applied to a very competitive, seven-year BS/MD accelerated medical programme. I was lucky enough to get in and embark on a journey which started with three years of college and then led to medical school. I did all of this training in Philadelphia before completing my residency in New York City in anaesthesia, and then doing a one-year pain fellowship in the Boston area.


JAP: What drove you to choose anaesthesia as a career?

PS: I think that anaesthesia is a very well-rounded career. There is an acute medicine component which is in the operating room. Our job is to literally keep a patient alive and well during a procedure while also having them sedated enough so that they have no conscious awareness of the operation. This is a delicate art which involves a myriad of different pharmaceuticals and understanding of the physiology of the human body, as well as a keen awareness of the patient at hand and their particular medical history. It involves having the composition to stay calm in a variety of clinical scenarios, but also having the quick reflexes to act if any particular aspect of the delicate interplay goes awry. Therefore, I believe the field touches on a variety of different knowledge bases, and personality traits. To me, it is a perfect balance between my nature to connect with individuals and help them feel calm, as well as personal individual critical thinking.


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?

PS: Anaesthesia involves the airway first and foremost. Unfortunately, the recent pandemic has led to a lot of respiratory complications for any patients during viral infection and even after. For a patient to go under general anaesthesia, it is a huge stressor on the body, and thus the impact of any sort of pathogen we don’t know enough about can be a very tenuous and unpredictable situation. Therefore, anaesthetists have been put under an enormous amount of stress over the past year navigating this novel virus, and the ensuing conditions have been an ongoing challenge for all providers.

In addition, many anaesthetists have been exposed to the virus themselves, given they are in close contact with patients daily and with their airways and breathing mechanisms. Thus, it is a journey for anaesthetist to remain safe and calm themselves while providing the best care possible to patients during this difficult time.

In fact, this will likely be something that goes down in history as one of the most eye-opening parts of a physician’s career if they are actively practicing anaesthesia during the current state of affairs.


JAP: What’s the best part of your job?

PS: The best part of my job is that I can provide a sense of calm and safety to patients while they undergo a variety of different procedures. Whether it be an elective procedure that the patient has chosen, or a life-threatening procedure which puts them to the brink of death. In all of these situations, the human touch is extremely important, and I have a personal ability to affect a person’s experience by my own mannerisms and demeanor. This is extremely powerful and humbling at the same time.


JAP: … and the worst?

PS: It is always difficult to explain to patients that the outcome they will have may not be exactly what they expect. For example, healthy patients may have a prolonged provost operative course in which they are healing much slower than they would have expected. After a pain management injection, a patient may not be cured of their pain instantly, and instead it might be a slow process requiring a lot of patience. This can be very difficult for a physician to relay to a patient because it involves a delicate balance of an honest scientific conversation plus an understanding of the patient’s baseline mindset. Therefore, setting appropriate expectations can be a challenging part of anaesthesia, pain management and –to be honest – most physicians’ careers.


JAP: What has been the highlight of your career so far?

PS: The true highlight of my career has been the opportunity to work with Dr. Bray and the DISC Sports & Spine Center group. He, himself, is a world-renowned surgeon who has a genuine and immense following for his precise surgical techniques and clinical care outcomes. My husband and I both feel grateful daily to have joined the incredible team that at DISC. We know that it will allow us to utilise our talents and training to the greatest extent possible for our patients.


JAP: Are you currently involved in any scientific research within your work?

PS: I would love to get involved in more research about how anaesthesia can affect the brain, both intra-operatively and post-operatively, and if there are any long-lasting effects for some individuals. Although we have become so sophisticated in the use of our medications and dosages, there still remains mystery around the exact mechanisms of action of many of our top sedatives.


JAP: If you weren’t an anaesthetist and pain management specialist what would you be?

PS: I think I would be involved in public speaking, whether it be healthcare globally, mental health, or personal development. I believe having strong role models and mentors for the population is more important now than ever, and to be a voice that advocates for positive mental and physical wellness is essential.


JAP: What would you tell your 21-year-old self?

PS: I would tell my 21-year-old self to trust the process. Often, when we are younger, we believe that everything we do at a young age will ultimately dictate our future. Of course, this is true in many ways. The sort of education we have and resources we utilise in our younger years often CAN dictate where we end up in our career path. However, there is a component of growth and evolution.  When we are in our twenties, we may not know EXACTLY the destination we want to end up in, and that is perfectly okay! Normalise uncertainty, and embracing the journey is the key!


JAP: If you were Health Minister for the day what changes would you implement?

PS: If I were Health Minister for the day, I would make many changes in regards to access to mental health resources for the community. In this country, access to mental health resources can be very cost-prohibitive and, therefore, many individuals are not able to seek the treatment that they need. In addition, even though there is open conversation about the concept of mental health and wellness these days, there still remains a stigma about actually MAKING the leap to pursuing help. Normalising the need to focus on both mind and body wellness is the goal, and if I were Health Minister, I would try to highlight the importance of full and overall health maintenance.


JAP: Away from the clinic and operating theatre – what do you do to relax?

PS: Getting out of my mind and into my body is key. I always talk about the mind-body connections for all of my patients, and so I do have to practice what I preach. One of the major reasons we moved to California was because of the ability to enjoy an outdoor lifestyle. I enjoy going to the beach with my dog, going on bicycle rides and doing yoga. In fact, I am a certified yoga teacher, a modality that I’d like to utilise for my own wellness as well as a technique I use to educate patients.


JAP: How do you think the future looks in the field of anaesthetics and patient experience and what are your predictions for 2021?

PS: I think that individuals have a true respect for anaesthesia given the pandemic. People are understanding medicine in a different way than before because the news and media is explaining what viruses are and how they can affect the body and respiratory system. Anaesthesia starts with the airway, how a patient is breathing before, during and after surgery: and most importantly, under general anaesthesia.

Knowledge is power, and if the general population understands what anaesthesia means under different circumstances, such as having certain medical conditions, they will have a variety of more questions for the provider. I have noticed already that patients are asking a great deal of intricate questions about the coronavirus and its related vaccination, as well as the effects of anaesthesia on the overall body. I am impressed with the knowledge that a lot of my patients now have, but – at the same time – I do believe it is my job, as always, to provide them with the most scientific information available versus what may be floating in the media. Therefore, I think that now, more than ever, physicians have to make it a priority to educate patients and help them understand the whole process that they will be going through.