My first five months of GP Anaesthesia….the adventure it has been

It would probably be of no surprise to you that balancing being a father, a rural GP, husband and newly qualified GP anaesthetists (GPA) is not for the faint hearted. Throw into that moving to a country area away from your support network and into a new set of circumstances makes it a little more difficult. But sometimes that isn’t quite enough, how about a heavily pregnant wife and then a new little one?

Well… Welcome to the last five months!

Please don’t get me wrong it has been one magnificent journey and has been instrumental in bringing us close as a family and solidifying in me a strong desire to become a rural GP.


Now the anaesthetics has been quite interesting.

I have had a laryngospasm that didn’t respond to escalating manoeuvres and needed intubating. I’ve had an unpredicted difficult airway in a seemingly easy patient. Then my favourite, the sick laparotomy in the middle of the night that needed lines and transport, intubated and ventilated to the big smoke.

It simply amazes me that with one year’s intensive experience and assessment, I am anaesthetising independently. I certainly do not feel out of control and am not anaesthetising outside of my comfort zone but consider it a privilege to run weekly elective lists and participate in the on-call roster.


See what I haven’t told you about is the support and mentoring that I have received down here. It is a pilot program for newly qualified GPA funded by GPET and administered through WAGPET.

It has eased my transition into working life and allowed for us to have another GPA on-call with us when we started. It was also essential in learning about the idiosyncrasies of our regional hospital, being aware of our environment (equipment, drugs and staff) and importantly patient selection and refusal.

The first patient I sent to Perth was an 80year old woman with appendicitis, which was diagnosed on CT. I sent her firstly and mainly because of her critical aortic stenosis (Valve area of 0.9cm2 and ejection fraction of 27%) and secondly because she was relatively well despite her CT findings. Conversely if she had an acute abdomen, I would have phoned a friend/mentor and cracked on!


Being optimistic about the future and committed to becoming an excellent GPA, I realise that experience cannot be bought and wisdom can only acquired with a teachable attitude.

So being I am being intentional about learning, continuing to read my favourite journals (Anaesthesia and Intensive Care, Continuing Education in Anaesthesia Critical Care and Pain, Tutorial of the week), attending some excellent courses recommended by airway experts like Minh Le Cong and will be upskilling when I can.

I have developed an obsession about my checking routines before giving the first bit of white stuff and a compulsion to organise my anaesthetic trays and drugs in a certain way, both hallmarks of a neurotic anaesthetic type.

Please stay tuned for more musings of a young rural GP anaesthetist trying to bring the best evidenced based care to country WA.

JR (Ortho Ninja)


  1. minh le cong says

    well written JR. look forward to the next instalment! docs like you allow rural hospitals to stay open and provide a vital service to remote communities. we are of the one belief that a patients location should not determine the level of care we should or can provide.

  2. Jonathan Ramachenderan says

    Thanks Minh. Absolutely.

    I love the idea of bringing the best medicine and techniques to the bush. We are pretty well supported to up skill and attend some cool courses which helps the cause of the bush doctor.


  3. Good to hear how you are going…I reckon the mentoring of new GPAs is essential as settle into a new environment without immediate FANZCA backup. And setting up a routine/organising the work environment to work for you is vital.

    I do wonder if theres scope for a network of GPAs to share ideas…we tend to do this in silos, either through annual conferences or upskilling in each State, or thro blogs and courses like BroomeDocs and STAR etc.

    When I was trying to research GPAs and access to difficult airway equipment, it was real hard to find out how many GPAs there are ‘out there’ in rural Oz, let alone to contact them. Theres so much potential to share ideas and advocate for better standards/equipment/training if we can do so collectively.

    Perhaps a rural Oz GP-anaesthetist list server or email newsletter? Its not so much the young guns like JR who need this – they are alrady enagged with social media and blogosphere – its trying to get new paradigms out to those who dont access such media or who operate in silos.

  4. Jonathan Ramachenderan says

    Yes. I am totally a young gun, a “proposal assasin” if you may.

    Tim that is an excellent idea.

    Before I was about to finish, I had the same inclination. There was a faint idea of doing an audit of the practising GPA’s in WA and doing some quick workforce statistics such as age, hours of gassing, years of experience and location. This as you can imagine from the last 5 months I’ve had, fizzled out!

    It would be great to connect on a national level. The ANZCA has the Rural SIG meeting every year which GPA’s are involved in. However a national GPA society/organisation/body would be excellent.

    With the vision of supporting GPA’s, organising networking events and providing education (getting the original propofol assassin Minh Le Cong to present) may be a start.

  5. Well, there is a rural GPA group
    But it’s under FANZCA and costs $$$ to join

    I do wonder if ACRRM would be a better conduit – perhaps a quarterly rural GPA newsletter?

    And if it was bipartisan, could hook up with (dare I say it) the RACGP and get both Colleges to forward to their members…

    Give me a call sometime or email me.

    A propos surveys of rural GPAs, I have some data on workforce stuff. It should be published sometime, will forward you a copy…

    Happy gassing1

  6. Kasu Pras says

    I found your article very interesting.I’m currently a resident at a tertiary hospital in Perth and hoping to join gp training and later apply for gp anaesthetic training. I would very much like to talk to you and gather some more information around that area.
    I would be very appreciative if you could reply to me and provide your contact details for me to get in touch with you,
    Many Thanks,

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