CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

Guedel’s Aphorisms

by
  • Larson, Merlin, MD
| Apr 23, 2018
larson

The name of Arthur E Guedel, MD, has been mentioned in CSA communications several times over the past 25 years. Dr. Guedel was a well-known California anesthesiologist from Los Angeles who practiced in the first half of the 20th century. Recently, the Guedel Collection at the UCSF Medical Library has been given an endowment to digitize Dr. Guedel’s letters.

CSA has created a task force to advise the archivist at UCSF on how to select materialsGUEDEL-PORTRAIT- that are of significant enough value to merit dissemination on the Calisphere website. His letters reveal how difficult it was for him to justify his physician-anesthetist fees at a time when surgeons and hospitals often hired “technicians” to provide anesthesia.

Scattered throughout Dr. Guedel’s documents are several short notes written on scraps of paper that pertain to how he should behave as a physician. These are not letters but are notations directed to himself as a reminder of how to improve his image as a physician – anesthetist. Many of them are relevant, insightful, and apropos for the times we live in:

  • Patients fear an operation. Minimize that fear.
  • If you have nothing useful and important to say, don’t talk.
  • If a mistake has been made by others, do not make accusations. Nothing is gained, and you could do damage.
  • Learn to remember your patients. They will be hurt and offended if you do not recognize them later in the hospital.
  • Don’t blame others for what goes wrong, even if they are to blame.
  • It is professional suicide to cultivate work with one particular surgeon. You become a servant instead of a professional.
  • It is your duty to work with surgeons you don’t like.
  • Be on time. Surgeons don’t like to be kept waiting.
  • Be not just a scientist but also an anesthetist, and not just an anesthetist, but also a physician.
  • Don’t sit back and bask in the warmth of the fire unless you bring in your share of the wood.
  • For what are you working? Wealth? Honor? Glory? Contentment? Obituary? Or just for the joy one gets when he drops a coin in the blind man’s cup?
  • My first thought was that hospitals need to be whipped, but now I say hospitals need to be taught.
  • Surgeons who use “technical anesthesia” think it is satisfactory because they know no better.
  • Some private hospitals find “technician anesthesia” profitable.
  • Develop the habit of a pre-anesthetic visit. But a tactless word might make the visit more harmful than helpful.
  • It is well to report your errors at anesthesia meetings, but better to report them as errors of your knowledge rather than as your own.
  • You will continue to make errors as long as you live.
  • Mistakes? You will make them. Most are harmless, some are disastrous. How will you explain? Tell the truth but not necessarily the whole truth.
  • Seem to minimize your successes but do not actually do so. 
  • Better to say of a method: “I like this best”, rather than “This is best”, even though you are convinced that it is BEST.
  • Accept praise humbly and graciously, and then change the subject.
  • Humility attracts the friendship of thinking men.
  • You will be invited to do free work. (Physicians, ministers of the gospel, nurses, sisters of charity.) Usually the financial return is greater if you do not send a bill.
  • Free work? There is no such thing as free work. There is always some compensation.
  • If you are helping no one by talking, then don’t talk. If you are hurting someone without worthy benefit to others, then don’t talk.
  • You cannot put on a bluff at a medical meeting, because physicians as a rule are polite they will know the truth but will not challenge you.
  • Don’t disregard convention. Eccentricity is a dangerous toy.
  • Carelessness in personal attire will interfere with one’s personal progress.
  • One’s opinion loses value according to the readiness with which it is given.
  • An opinion that is pried loose is usually more valuable.
  • Teaching makes you classify your thoughts, increases your ability to side step, and makes you think.
  • You don’t need to be a skilled public speaker if you have something to say and can tell it so it will be understood.

Seventy-five years after Guedel wrote these notes, we as a medical specialty still have an image problem. The public knows that we put people to sleep but the public has limited knowledge of the significant roles we play in the ICU, ambulatory care, recovery room, and pain control.  

Maybe we are sometimes crass, pecuniary, negligent, insensitive, rude, unprofessional, and short. It might be well to take notice of many of Guedel’s “aphorisms” relating to our public image. I can only state that I wish I had been aware of some of these notes at the beginning of my career instead of at the end. Certainly, some of these ideas should be discussed with our trainees. It is of interest that Dr. Guedel never clearly promoted his image by proclaiming his more advanced training. Rather he thought about how he might apply the common courtesies of everyday life into his own life and practice.

 

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