People who influenced my practice

doi:10.1136/bmj.331.7507.33

BMJ 2005;331:33 (2 July), doi:10.1136/bmj.331.7507.33

Filler

People who influenced my practice

Many doctors influence what we do by what they teach us. A fewhave disproportionate effects because they do not necessarilyintend at that moment to instruct. This has happened to me onmore than one occasion, and at least one affected my lifetimepractice.

In the days when rigid bronchoscopy was current (the marvelsof the flexible instrument had yet to be developed) the lateDr R Machray taught a method, ghastly to contemplate now, oflocal anaesthesia. He had just supervised my administrationof cocaine to a conscious patient. The bronchoscopist, withwhom he worked regularly, was Sir Clement Price Thomas, a doyenof both thoracic surgery and of bronchoscopy, who was, I thought,unlikely to need support from a tyro anaesthetist.

I therefore left the operating room, but Dr Machray hustledme back with his never to be forgotten words, "Make encouragingnoises, my boy, make encouraging noises." From this I learntthat, to be successful with regional anaesthesia in a consciouspatient, it is important to maintain contact with the patient,and thus sustain their confidence.

That lesson is simple and widely practised today. But it washis phraseology that struck me and has never left me since.

John Lunn, retired academic anaesthetist

Chepstow