Interview with: Paul Goulden, Consultant Anaesthetist, Dewsbury and District Hospital

APN: What did you train as, and where?
PG: Very much a local boy, I read medicine at the University of Leeds, qualifying in 1974. Apart from a year doing surgery and obstetrics in the north–east, where my wife was brought up, all my training posts were in West Yorkshire. I passed my fellowship while I was a registrar at ‘Jimmy’s’ in Leeds and completed my higher training as a senior registrar on the old Leeds/Bradford rotation.

APN: How long have you worked in your current role?
PG: I was appointed in 1982 to a department of five consultants covering three small hospitals. After some time, consultant numbers got into double figures and services were centralised at Dewsbury and District Hospital. For the past couple of years we have been part of a Trust covering Wakefield and Pontefract, as well as Dewsbury, so now I am part of a department with over thirty consultants. I may not have moved but the job is certainly not the same one I was appointed to!

APN: What do you like to do outside of the Hospital?
PG: Probably the most regular activity these days is associated with the Church, both the Dewsbury and Mirfield Methodist circuit are very active, which means there are a lot of committee meetings! I am Secretary of the Dewsbury division of the British Medical Association and am also a frustrated train spotter and collector of railway books.

I have been a member of the History of Anaesthesia Society almost since its foundation and have recently found time to undertake some research in this area. Essentially a couch potato (see photo) I do, from time to time, feel the urge to put my boots on and do some walking.

APN: How and why did you decide you wanted to do the job you do?
PG: I was in hospital quite a lot as a teenager and it convinced me that I wanted to study medicine, although I had very little idea of the various career paths available - being from an entirely non-medical family. I was hooked as a student. The anaesthetic teaching in Leeds at that time was very good.

I spent part of my elective time with the University department for further exposure and they didn’t manage to put me off! After I trained I wanted a job in a smallish department where I could make my voice heard early in my career rather than risk being treated as a perpetual senior registrar for the first few years.

APN: What aspects of your job do you find most rewarding?
PG: Surprisingly, the patient contact. People don’t think anaesthetists have any, but the pre-operative assessment period and the time in the anaesthetic room can be extremely intense. You have to exchange a lot of information and build a trusting relationship in a very short time. I enjoy working as part of an ever-changing team in the operating room and being part of a mutually supportive department where everyone is prepared to contribute an idea or lend a hand.

Anaesthesia is physiology and pharmacology in action in the sort of time scale I can cope with - I am far too impatient to wait two weeks for a drug to work! Trainees are a constant delight. They all seem to know far more than I did at their stage but it is nice to be able to explain things they didn’t understand or help them improve a technique. It is a pleasure to see them making progress in their career even if they choose not to go on in anaesthesia but a particular delight to see some of them becoming consultant anaesthetists (including three we have welcomed back to Dewsbury).

APN: Are you a member of any academic or fellowship organisations, and if so, do you think they support anaesthetists in doing their job?
PG: I am a fellow of the RCA and a member of the association of anaesthetists. They cover slightly different areas although there is some overlap and co-operation in the area of educational provision. I think they both do a great job in setting and maintaining standards and contribute to the high regard in which British anaesthesia and anaesthetists are held.

The more I look into the history, the more I realise how different the speciality would be without strong central organisations. The British Association of Day Surgery is a valuable multi-disciplinary group with a clear special interest. I am also in the European Society of Anaesthesia and think this body is going to be much more important in the next few years both in setting and harmonising standards and promoting the exchange of ideas.

APN: What do you think are the most important changes to anaesthesia over the last decade?
PG: The routine availability of a range of reliable monitoring in all anaesthetising locations together with high quality disposables has made the job much easier over the past few years. Against that, expectations are higher. Many patients are both older and sicker than those offered for surgery when I started. There is a definite feeling that alternative providers are ‘cherry-picking’. Consultant involvement out of hours is much greater and the new consultant contract has probably arrived just in time to stop things getting completely out of hand.

New conditions of work for trainees have removed the spectre of the half-asleep watching the half-awake, but the training programmes are taxing. Unfortunately the pharmacology seems to have reached a plateau, with interesting tweaks rather than major developments the norm.

APN: How much further can things be advanced?
PG: Ideally I would like to be put out of business by an end to disease and trauma, which require surgical intervention. I can’t see that happening in my lifetime, let alone my professional career. On a realistic level, we are still a long way from being able to provide all our patients with safe reliable anaesthesia with no postoperative pain or nausea, no complications and no risk, no matter what is wrong with them. We also have a responsibility as a profession to see what we can do to improve the standards of anaesthesia in the developing world where lightly trained staff have to do so much with so little.