Promoting Anesthesia to the Public: A Win-Win Situation

Warren K. Eng, M.D.

“You’re the one who knocks me out, right?”

his is the most common response from my patients when I introduce myself as their anesthesiologist. During the ensuing 20-minute conversation over their anesthetic plan, it becomes apparent that these anxious patients (and their stressed families) have been so focused on the surgery that they are unaware of the risks/benefits and alternatives to various anesthetics. Regional blocks, epidurals for postoperative pain control, endotracheal intubation, arterial lines — each component of the anesthetic plan can be a cause of discomfort and anxiety to the uninformed patient.

Beyond the needless anxiety on the day of surgery, the general public’s lack of education regarding the role of anesthesiologists can lead to the cancellation of elective surgeries. Patients uneducated about the aspiration risk posed by a full stomach may take one last bite before heading into the hospital. Lack of anesthesia knowledge can lead to untreated chronic pain as sufferers are unaware of the latest treatment advances for their ailments. Misinformation may lead to brash, last-minute decisions about issues that could have been settled earlier such as whether to opt for that caudal for a precious child’s orchiopexy. This is frustrating for both patients and anesthesiologists alike as a lack of public understanding translates into needless anxiety and delay of care.

An equally important benefit from raising the public’s awareness of anesthesiology could be an increased call for board-certified anesthesiologists. Mark J. Lema, M.D., Ph.D., in his November 2003 ASA NEWSLETTER editorial, contends that anesthesiology is at a crossroads. With the advent of safer treatment (laryngeal mask airways, desflurane, propofol, pulse oximetry, rocuronium, minimally invasive procedures, etc.), he states that intensivists, hospitalists, emergency personnel and other health care professionals are treading on ground traditionally covered by anesthesiology. “What importance does society now place on having a board-certified anesthesiologist or certified registered nurse anesthetist for their minimally invasive procedure? Politicians and the public are largely ignorant about the subtle risks of anesthesia in this setting, but they are not stupid,” he contends.

Raising the profile of anesthesiology among the lay public, then, could improve overall patient care by decreasing anxiety and easing the transition into the operating room (O.R.) Increased education also could lead to a public debate over the risks and benefits posed by nonanesthesia-trained personnel using anesthetic medications and devices. How then do we increase the general public’s awareness of our field? Three obvious solutions present themselves.

For starters we must partner with our surgical colleagues and circulate patient materials at preoperative surgical visits and include information in admission packages and day-operation materials. ASA has excellent patient education materials on its Web site at <wwwASAhq.org/patientEducation.htm>. These documents range from a basic primer on anesthesia to coloring books designed to familiarize pediatric patients with their perioperative care to detailed handouts on obstetric anesthesia and the management of acute/chronic/cancer pain. If made available in all surgeons’ offices, day-surgery precare suites and labor and delivery or with admission materials, the preoperative anesthesia visit likely would proceed at a much higher level of discussion with less patient anxiety and discomfort.

Secondly we should continue to promote our specialty in lay press articles such as the July 12, 2004 U.S. News & World Report article on “Hidden Specialties” by Thomas Hayden. Available at <www.usnews.com/usnews/health/hosptl/articles/12hidden.intro.htm>, the article emphasizes anesthesiology as the “human face of surgical care.” By walking through a day in the life of a board-certified anesthesiologist at the University of Chicago, the reporter explains the nuances of perioperative critical care, from line placement and narcotic titration to O.R. scheduling and code emergencies.

Finally we must participate in and support a vigorous ASA as it strives to raise and maintain the standards of anesthesiology practice to ensure a high level of patient care. Our profession’s “face” and actions on multiple legislative, media and economic fronts are advocates for our patients and our specialty.

To ensure the continued high standards of anesthetic care, we owe it to our patients to increase public awareness about anesthesiology and the role of anesthesiologists. As patients understand more of our field’s basic principles, anxiety may lessen and more informed decisions may be made. In the future, educated health care consumers may increasingly demand professionally trained, board-certified anesthesiologists — a win-win situation for patients and the future of anesthesiology.

Please send any topic ideas, sample articles or questions to the editors of “Residents’ Review” at <residents.review@ ASAhq.org>.

Warren K. Eng, M.D., is a CA-1 resident at the University of North Carolina Hospitals, Chapel Hill, North Carolina.