I am a physician. I am an anesthesiologist. People think that anesthesiologists do not have relationships with their patients — that those meaningful doctor-patient interactions do not take place in the brief time anesthesiologists have to meet their patients just before surgery. Many would say that the anesthesiologist’s job is to give the patient no experience; that is what anesthesia is — amnesia, hypnosis, lack of feeling, thus, a lack of experience. This notion is so pervasive that hospitals do not require or even have a formal mechanism for getting feedback on patients’ anesthetic experience. In most hospitals, there is no postoperative inquiry of patient satisfaction on anesthesiologists. Yet, we know from the recent patient satisfaction movement that physicians benefit from patient feedback. So why not anesthesiologists? Is there nothing that anesthesiologists do that is worth patients weighing in on?
Part of the problem is that most patients don’t know exactly what it is that we do. I’ve had patients who recognize the importance of what anesthesiologists do medically: “The surgeon will take care of my gall bladder, but you are going to take care of my brain, heart, and kidneys, right?” This is, however, the exception. Earlier in my career I spent a good portion of my time with patients and families explaining that we don’t just “put the breathing tube in and leave the operating room.” It was important to me that they knew that I was a physician and would apply the Hippocratic Oath as vigorously as their other physicians. But countless eyes glazing over helped me realize that explaining what we do medically was not precious time well spent. Patients assumed I’d be technically competent. What they wanted to know was that we cared.
Now, I, and most anesthesiologists, develop a relationship with patients in that brief, poignant moment, after reviewing their medical histories and doing their physical exams. I sit down and make eye contact and let them know that I care: “I will give you the anesthetic that I would want to have”, “I will treat you like you are my own father”, or “I know this is a lot of information; the important thing to take away is that we will take the best possible care of you.” Does midazolam, the antianxiety/amnesia–causing medication, take that moment away? I don’t think so, and certainly not for the family members who are even more acutely experiencing every minute of their loved one’s care in the operating room. In the operating room, as they are drifting off to sleep, I, and most anesthesiologists, try to keep them calm and positive: “while you are asleep enjoy fly-fishing in Montana, like you told me about”, or “you can start dreaming about those lapping waves in Kauai — you said that is where you have always wanted to go.” A good patient experience is part of a successful anesthetic.
I believe that patients and their family members want to be involved in the medical care that affects them. I believe that anesthesiologists want specific feedback about the doctor-patient relationships they are forming — what they are doing right or could improve upon. Patient feedback is an important contribution to ensuring great medical care. Wrapped up in patients’ feedback is the question of whether your patients understood you, felt their care was coordinated, and got the feeling their wishes would be observed. Let’s not leave anesthesiologists out of this revolution. Let’s learn what matters to our patients and find out if we are serving their needs. In the end, we cannot measure the importance of a doctor-patient relationship by its duration — only by what the patient takes away from it.