As I was ripping out pages of an old edition of the BMJ to stuff my wet trainers with, a quotation caught my eye. It was made by Jerry Heneghan, the director of product development at Human Sim, who manufacture the medical equivalents of flight simulators.
‘When I was a pilot, I was evaluated every year on a flight simulator to check I was still good to fly. I don’t see why that shouldn’t be compulsory for surgeons as well.’ BMJ 2014;349:g5642
No, we know you don’t see.
It doesn’t happen often, but I sympathise with the surgeons at whom this is directed. For many years anaesthetists have been compared to pilots by everyone, apart from anaesthetists themselves. I do not know of one anaesthetist who agrees with the belief that a pilot flying a plane is in any way similar to anaesthetising a patient.
The uninformed talk about the excitement of take off and induction, the required attention to landing and emergence, and the ‘boring’ bit in between which I assume means when the patient is kept alive, asleep, analgesed and unaware on auto-anaesthetist, while we go for our compulsory meal break.
Let’s be clear. Patients cannot be compared to aircrafts. Patients start ill and have surgery and anaesthesia to get better. They come in a variety of shapes and compositions, with underlying chronic problems and an acute pathological process requiring intervention, to improve the clinical condition or allow survival. Their response to any intervention is variable; patients do not come with a manual and have not read the same books we have. An identical anaesthetic ‘recipe’ will kill some patients yet barely affect others.
The aircraft is standard. Regularly maintained, with any fault being immediately repaired before flying. When serious faults are discovered, the aircraft is withdrawn from service while it is investigated and all other planes are grounded and checked for the same problem. Air travel is not a life saving procedure. No pilot takes the faulty plane, full of passengers, low on fuel, into a storm without navigation, to investigate and fix the problem at 30,000 feet, do they? Of course not, but this is a much closer representation of the challenge of emergency surgery.
I would concede pilots must ‘first do no harm’, particularly as their ‘patients’ are all well and off on their holidays, but there the similarity ends.
If pilots want to compare flying and medicine, I suggest they use anaesthetic machines for their analogy. They need to be switched on and started up, if you’re very lucky they will all be the same in your theatre suite, they are maintained and checked each day. We would not consider using a machine with a fault until it is fixed and undergone its safety checks successfully.
Despite the increasingly digitalised new machines, human beings are still more complex than any hard drive.
And please, do not ask me about my weekend on call which culminated in being stranded on a remote Hebridean Island, with a head injured, intubated and ventilated patient while the pilots checked into a B&B for a meal, a couple of drinks and a sleep until morning because they had reached the limit of their flying time that day and required a rest.
Waiting without so much as a toothbrush, the only flying I did was off the handle.