El british medical journal, volume 2 294 de mayo de 1987 1157

BRITISH MEDICAL JOURNAL VOLUME 294 2 MAY 1987 1157

habitual lateness will hinder their progress up the greasy pole and be an absolute bar to success in private practice should they have any aspirations in that direction. If trainee surgeons could also be taught that preparing a patient for their knife takes longer than the five minutes they generally allow for changing and scrubbing up knife to skin at 8 30 am would become more of a realitv than the myth it now is. But then Mr Datta would have no time to write his delightful articles. W AVEI ING Middlesex Hospital, London W'IN 8AA

SIR,-"We never send for the patient until we see the whites of the surgeon's eyes," the theatre staff have forcibly made clear to me at one of our local hospitals. Mr Pradip K Datta rightly laments the lack of punctuality with which operations begin and finds his anaesthetic colleagues mainly to blame. The time has come for the profession to reach a consensus on the meaning ofthe "starting time" of a theatre case and to encourage its realistic use by all concerned. A difficult aspect of our work as surgeons and anaesthetists is the scheduling of that work in the best interests of all those involved in the safe conduct of an operation: the patient, occasionally parents, ward staff, porters, anaesthetic and theatre nurses, and ourselves. There is, however, no agreement on the meaning of the starting times around which all these participants are required to perform their duties. These times, appended to tolerant noticeboards throughout our hospitals, seem to signify anything from "sending" (even if the patient to be sent for is six floors away) to the moment of knife to skin. Like Mr Datta, I have realised the second definition on onlv two occasions despite frequent monumental efforts to mobilise the system accordingly. It is one of the delusions of doctors that they alone control such events. Behind the lack of precision lies a widespread inability to face certain practical facts. Time is required to transport a patient from the ward; to book him or her into the theatre suite; to establish rapport, monitoring, and anaesthesia; and, finally, to wheel the patient into the theatre, lift him across, and settle him under the drapes. Trhe dura- tions of these stages-could profitably be measured and recognised in planning theatre time. The dangerous fiction that an anaesthetic is merely a two minute squirt on the way to the knife might then finally be put to rest and the surgeon given a reliable time at which to don his wellingtonis. There is a need for a statement from the Royal College of Surgeons and its faculty ofanaesthetists on this matter. KEITH L DORRINGTON Nuffield Department ofAnaesthetics, John Radcliffe Hospital, Oxford OX3 9DU

SIR,-It is regrettable that some statements made by Mr Pradip K Datta, should have been published. Wick has a fairly small medical community whose members are easy to identify, which is particularly unfortunate as so many of the state- ments made by Mr Datta are untrue. It is simplistic to assume that a surgical operation starts when the knife strikes the skin. To have a set "knife in" time is a silly objective and certainly one that is way down the list of priorities of any anaesthetist. Getting the patient tooperation adequately assessed (after discussion with thc patient and colleagues), well prepared, and as stable as possible is surely more important. That this is achieved in daily

surgical practice by all the relevant staff being in the hospital well ahead of time is regarded here in Caithness as selfevident. The suggestion that three minutes is the time that any reliable surgeon would take for a surgical consultation is ridiculous. In any case, even if the person Mr Datta refers to were half an hour late at two patients booked every quarter of an hour this would mean only four patients in the waiting room-surely a small waiting quota. In fact, however, the statement regarding a surgeon leaving home to drive 20 miles to a clinic at 9 30 am is not correct as far as Caithness is concerned. It is typical of the exaggeration of Mr Datta's claim that he has started his list on time only twice in 19 years. Usually weassociate MrDattawithlighthearted, humorous articles. It is rather a pity that he has overstepped into unkindness on this occasion and that his article hasdegenerated intoan unwarranted assault on his professional colleagues past and present. W R ANTONIOS IAN J BURNS HUGH B CRUM IAN H FARQUHAR

(Caithness (General Hospital. Wick, (Caithne%s KWI SLA

Testing the sense ofsmell

SIR,-While Dr Victoria Moore-Gillon's leading article (28 March, p 793) provided an admirable introduction to the new olfactory testing kits, she did not address the importance of using the right odours in the clinical testing ofolfaction. Many odours can be detected by trigeminal nerve endings in the nasal cavity. The clinical relevance of this was shown in a simple study in which many of the "standard" odours (pepper- mint oil, camphor, cloves) failed to detect known lesions of the olfactorv (cranial nerve I) pathway.' By contrast, these were

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