This much I’ve learnt: Dr Samantha Shinde
Consultant anaesthetist and RSM Council Trustee Dr Samantha Shinde talks about what led her to a career in medicine, her work at Bristol’s major trauma centre and how we can all contribute to the drive for net zero in healthcare.
Growing up, a close family friend was a GP. His vocation as a doctor, caring for and understanding his patients, was inspiring
When I was applying for medical school, I volunteered in an old people’s home and worked with disabled children in the summer holidays. It made me realise how much I enjoyed caring for and talking to patients.
Having that experience was important because once you start in a career in medicine, the opportunities to step out of it are quite hard. You really need to understand that medicine is a vocation and that's what you want to do. Dip your toes in, do some work experience, chat to people who've done medicine before you take the plunge.
The same goes for choosing a specialty once you’ve qualified and done your foundation training. The RSM’s careers fairs are a good way of introducing trainees to the different specialties.
A broad understanding of medicine is a pre-requisite for anaesthetists
When I started training, a lot of people went straight into anaesthetics, but I carried on with more general training before specialising. It’s now a requirement for trainees applying for specialty training in anaesthesia to have a broader level of training in medicine.
I did rotations in obstetrics, care of the elderly, orthopaedics, surgery, emergency medicine and then anaesthetics. As a group, the anaesthetists were just incredibly good fun!
Where I work, at Southmead Hospital in Bristol, there are about 90 anaesthetists. We’re involved across the specialties, putting epidurals in for pregnant women, dealing with patients coming in with acute pain, putting patients to sleep in theatre and working as part of the major trauma team.
The best thing about being an anaesthetist is that you’re never bored
Southmead Hospital is the major trauma centre for the Severn region so there’s never a dull moment. You never know what's going to come through the door. It could be a 100-year old with a fractured neck of femur or a 21 year old coming off his motorbike. Working out what takes priority across the patient’s whole body – whether it’s neuro, bone fractures and so on – and applying my specialist skills and knowledge as part of the team is energising.
I also do a lot of work with the neurosurgeons specialising in stereotactic and functional neurosurgery using deep brain stimulators. Some of these patients have severe epilepsy and learning difficulties. Dealing with patients who don't want you to come anywhere near them is a challenge. You have to respect them, respect their family and give them the best care that you can.
Before the 24/7 stroke thrombectomy service at Southmead Hospital we never saw these patients in the emergency department
We've just had the funding to start a 24/7 stroke thrombectomy service at Southmead Hospital which is very exciting, especially considering how young some of the patients are.
Stroke thrombectomy is a time-critical, life-saving treatment and there’s been a push nationally to train up more interventional neuro-radiologists to carry out the procedure. It involves inserting a catheter into the groin and pulling out or dissolving the blood clot in the brain.
It’s amazing seeing how much better some patients are straight after the procedure, with many able to go back to daily living and working.
Just because I’m a consultant, doesn’t mean I can’t call for help
The stroke thrombectomy service is a great example of team working, with everyone primed to run at a moment’s notice. There’s great team spirit and camaraderie, and you can always call for help.
We are incredibly lucky at Southmead Hospital to have zero hierarchy, with everyone, from anaesthetist to healthcare assistant, from recovery nurse to hospital porter, playing equally important roles. Looking out for each other and respecting their roles really does get the best out of everybody.
I first encountered the RSM when I was a medical student at University College Hospital
Now I’m based in Bristol, the RSM club has come into its own. Fundamentally the RSM provides education, but being able to stay at the club hotel [Domus Medica] after a meeting is a side of membership that I really benefit from.
Being able to connect with the RSM online has dramatically changed things for people who are outside London. I’d have to take a whole day off to travel from Bristol for an afternoon meeting lasting only an hour or two and appreciate having the option to attend online.
Becoming an RSM Council Trustee gives you a chance for your voice to be heard during important discussions about the future of the Society
There are various committees that Trustees get involved with at the RSM. I sit on the Audit and Risk Committee and the Programme Approval Committee. Being part of the decision-making process on important issues is challenging but gives you the opportunity to effect change.
Our President, Professor Roger Kirby, reminds us at Council meetings that the responsibilities of being a Trustee come with the understanding that you are voting and making a decision on behalf of both RSM members and the charity as a whole. You have to be absolutely comfortable with the decisions that you make and understand the implications.
For anyone considering applying for Council I’d say give it a go. Everyone on Council has a voice and is listened to. It’s a fantastic organisation and you’ll be working with some absolutely amazing people. The little black book of the RSM is enormous!
My inaugural lecture when I became President of the RSM’s Anaesthesia Section was on anaesthesia and the environment
Environmental sustainability has always been an interest of mine, and I’m the RSM Council representative for the UK Health Alliance on Climate Change. Before that I was chair of the environmental sustainability committee at the Association of Anaesthetists where I was Vice-President.
Anaesthesia contributes 2% of the NHS carbon footprint, mostly from volatile gases exhaled or vented into the atmosphere. A recent success story from the work of a cross-organisation group I was involved at the Association of Anesthetists has been the decommissioning by NHS England of desflurane[i], a volatile gas used in anaesthesia which has global warming potential 2,500 times greater than carbon dioxide.
I’m pretty sure this is the first time in the UK that an anaesthetic or medical drug has been decommissioned fully on environmental grounds. It’s a major breakthrough.
When it comes to tackling climate change, start small and start by looking at yourself
We can all play a part in reducing emissions. You don’t need to change the world – the little things all add up. Start by looking at how many flights you take, how you get to work, how much recycling you do at home and at work. At my hospital we got together as a group of anaesthetists to recycle all the biscuit and crisp wrappers our trainees get through when they’re working over the weekend.
We also audited the lights in our 26 operating theatres lights when they’re not in use at the weekend. We found they were on from Friday evening until Monday morning because no one switched them off. Now we've introduced measures to get them switched off, saving energy and reducing electricity costs for the Trust.
For people who want to do more, the Centre for Sustainable Healthcare runs fellowships programmes for doctors and healthcare professionals wishing to get involved in sustainable healthcare research and practice.
From a wider perspective, we need to work towards purchasing in the NHS as we would our fruit and veg. In the same way we can choose not to buy out-of-season asparagus from Chile, we should be able to choose not to buy drugs with, for example, environmentally unfriendly packaging. There are cost challenges of course, but purchasing based on environmental considerations, rather than price, has got to be better for the planet in the long run.
[i] https://www.england.nhs.uk/blog/putting-anaesthetic-emissions-to-bed/