Patient Perception of Anesthesia Providers
Anesthesiology professionals are experts in a wide variety of subfields, including anesthesia care, pain management and critical care medicine.1 Members of the anesthesia team include physician anesthesiologists, anesthesiologist assistants (AAs), certified registered nurse anesthetists (CRNAs), anesthesia technicians (ATs), certified anesthesia technicians (Cer.A.T.s) and certified anesthesia technologists (Cer.A.T.T.s).2 All providers have extensive training that equips them for quality patient care before, during and after a procedure. For example, physician anesthesiologists have 12 to 14 years of training and 12,000 to 16,000 hours of clinical training.1 Despite anesthesia providers’ roles in helping patients understand the surgery and anesthesia, monitoring patients throughout surgery and caring for patients during recovery,3 patients often do not understand who anesthesiologists are or what they do.4 Anesthesiology professionals should understand their position in various tasks and patients’ perceptions of their job.
The anesthesia provider’s duty begins long before the procedure itself, with an assessment of the patient’s risk/benefit ratio.5 When evaluating the patient’s health history and current condition, the anesthesiology professional may need to challenge the extent of the surgical procedure and even refuse to provide anesthesia for a dangerous and unnecessary surgery.5 Thus, the anesthesiologist serves a crucial role in preventing procedures that are not in the patient’s best interest.5 If proceeding with a surgery, the anesthesia provider gives the patient preoperative education about anesthesia and associated risks.4 Adequate and comforting communication throughout the preoperative period is paramount, as surgery can put patients in an extremely vulnerable and unfamiliar position.6 The anesthesiologist’s educational method can deeply affect the patient’s anxiety levels.7 As induction occurs, the patient’s perception of noise is distorted, and the anesthesia provider must ensure a quiet and calm location.6 Throughout the intraoperative period, the anesthesia provider’s care includes prevention of surgical site infection,8 ensuring patient safety,9 managing pain control, monitoring vital signs and controlling medical problems or chronic issues.1 After a procedure, the anesthesia provider will answer the patient’s questions, look for evidence for injuries or complications related to anesthesia and document completion of care.6 When discharging the patient, the prescriptions chosen by the anesthesiologist may permanently affect the patient’s life outside of the hospital, including use of opioid drugs.10 According to a study by Gerstein et al., the cardiac anesthesiologist may be important to surgical outcomes.11 Anesthesia providers are key to successful patient care before, during and after a procedure.
Though anesthesiology professionals do many tasks for the patient throughout surgery, they are still known as a “silent force behind the scene.”3 Many studies have focused on patient perceptions of the anesthesia provider, with mixed results. A review by Klafta et al. showed that patients were generally unsure of the function of the anesthesiologist after induction of anesthesia, and therefore may perceive that the anesthesia provider is not physically present throughout the entire operation.4 Similarly, a study by Nagrampa et al. found that patients in a Los Angeles clinic knew anesthesia providers put patients to sleep, but were uncertain of their exact role during surgery or outside of the operating room.12 In a hospital study in China, Li et al. found that less than half of all patients surveyed recognized anesthesiologists as qualified doctors, and 77.4 percent wished to receive more information about the anesthesiologist.13 In Singh et al.’s study of a rural hospital in New Delhi, most patients were unaware of the jobs of anesthesiologists or their role in the operating room and postoperative period.14 Most patients did not recognize anesthesiology as a separate discipline.14 Baaj et al.’s study of Saudi patients found that only 16.5 percent of patients knew what anesthesia providers do during a surgical intervention.15 In Hariharan et al.’s study in Trinidad, 10 percent of patients did not know who an anesthesiologist was, and only 59 percent knew the anesthesiologist was a doctor.16 Meanwhile, some data show that the anesthesiology professional’s demeanor affects patient perceptions, even if many patients are unaware of the provider’s role.17 Forkin et al.’s study found that patients perceived anesthesiologists displaying confident body language (i.e., hands on the hips, open stance) as more confident and intelligent, more like a leader and more recommendable to care for their family members.17 Evidently, patients are unaware of the anesthesiologist’s exact role, but they still notice the anesthesia provider’s conduct.
The anesthesia provider is critical to the patient’s care before, during and after surgery. However, many patients do not understand the field of anesthesiology, nor the anesthesia provider’s role during a procedure. In the future, anesthesiology departments should aim to standardize and improve perioperative teaching and communication with patients.4 Research should approach how patient perceptions (or lack thereof) affect anesthesia providers’ job fulfillment, stress and quality of life at work.3 Other clinicians’ perceptions and knowledge of the anesthesia provider may also play a role in patient understanding and satisfaction.18
1. American Society of Anesthesiologists. Role of Physician Anesthesiologist. When Seconds Count… Physician Anesthesiologists Save Lives 2020; https://www.asahq.org/whensecondscount/anesthesia-101/role-of-physician-anesthesiologist/.
2. American Society of Anesthesiologists. Types of Careers in Anesthesia. Anesthesia as a Career 2020; https://www.asahq.org/education-and-career/career-resources/anesthesia-as-a-career/types-of-careers-in-anesthesia.
3. Verma R, Mohan B, Attri JP, Chatrath V, Bala A, Singh M. Anesthesiologist: The silent force behind the scene. Anesthesia, Essays and Researches. 2015;9(3):293–297.
4. Klafta JM, Roizen MF. Current Understanding of Patients’ Attitudes Toward and Preparation for Anesthesia: A Review. Anesthesia & Analgesia. 1996;83(6):1314–1321.
5. Erb TO, Frei FJ, Moll J. The Anesthesiologist’s Role Assessing the Individual Patient’s Risk/Benefit. Anesthesia & Analgesia. 2012;114(2):476.
6. Kopp Vincent J, M.D., Shafer A, M.D. Anesthesiologists and Perioperative Communication. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2000;93(2):548–555.
7. Mohan B, Kumar R, Attri J, Chatrath V, Bala N. Anesthesiologist’s role in relieving patient’s anxiety. Anesthesia: Essays and Researches. 2017;11(2):449–452.
8. Forbes SS, McLean RF. Review article: The anesthesiologist’s role in the prevention of surgical site infections. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2013;60(2):176–183.
9. Wacker J, Staender S. The role of the anesthesiologist in perioperative patient safety. Current Opinion in Anaesthesiology. 2014;27(6):649–656.
10. Koepke EJ, Manning EL, Miller TE, Ganesh A, Williams DGA, Manning MW. The rising tide of opioid use and abuse: The role of the anesthesiologist. Perioperative Medicine. 2018;7(1):16.
11. Gerstein NS, Petersen TR, Ramakrishna H. Evaluating the Cardiac Anesthesiologist’s Role in Surgical Outcomes—A Reappraisal Based on Recent Evidence. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(1):283–290.
12. Nagrampa D, Bazargan-Hejazi S, Neelakanta G, Mojtahedzadeh M, Law A, Miller M. A survey of anesthesiologists’ role, trust in anesthesiologists, and knowledge and fears about anesthesia among predominantly Hispanic patients from an inner-city county preoperative anesthesia clinic. Journal of Clinical Anesthesia. 2015;27(2):97–104.
13. Li M, Ma L, Yu X, Huang Y. A Survey of Surgical Patient’s Perception about Anesthesiologist in a Large Scale Comprehensive Hospital in China. Chinese Medical Sciences Journal. 2019;34(2):140–146.
14. Singh T, Sharma S, Banerjee B, Garg S. Knowledge regarding anesthesiologist and anesthesiology among patients and attendants attending a rural hospital of New Delhi. Journal of Education and Health Promotion. 2018;7:12.
15. Baaj J, Takrouri MS, Hussein BM, Al Ayyaf H. Saudi patients’ knowledge and attitude toward anesthesia and anesthesiologists—A prospective cross-sectional interview questionnaire. Middle East Journal of Anaesthesiology. 2006;18(4):679–691.
16. Hariharan S, Merritt-Charles L, Chen D. Patient perception of the role of anesthesiologists: A perspective from the Caribbean. Journal of Clinical Anesthesia. 2006;18(7):504–509.
17. Forkin KT, Dunn LK, Kaperak CJ, et al. Influence of Sex and Body Language on Patient Perceptions of Anesthesiologists. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2019;130(2):314–321.
18. St. Michael’s Hospital. Poor understanding of anesthesiologist’s role during labor may affect maternal and fetal outcomes, Canadian study finds. Science News. Web: ScienceDaily; May 20, 2011.