GP Anaesthesia in Rural WA: The First Five Months

By , Dr Jonathan Ramachenderan published on 06/07/2020 Rural Generalism, General Practice,

So what's it like working in rural Western Australia as a GP and newly-qualified GP anaesthetist?

This week's guest writer, Dr Jonathan Ramachenderan, recounts his experiences from 2012. Jonathan is a palliative care doctor and GP anaesthetist now based in Albany, WA, and is a contributor at the BroomeDocs blog.


It would probably be of no surprise to you that balancing being a father, a rural GP, husband and newly qualified GP anaesthetist (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 GPAs 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.

Dr Jonathan Ramachenderan, Palliative Care Senior Medical Practitioner & GP Anaesthetist

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 be acquired with a teachable attitude.

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


Thanks Jonathan for your insights. This article originally appeared in Dr Casey Parker's blog Broome Docs - Rural Generalist Doctors Education in 2012, under the title My first five months of GP Anaesthesia….the adventure it has been. It has been published here with the permission of Jonathan Ramachenderan and Casey ParkerCheck out Casey's Broomedocs Podcast here.

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