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Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts
Address correspondence and reprints requests to David Hepner, MD, Department of Anesthesiology, Perioperative and Pain Medicine, 75 Francis Street, Boston, MA 02115. Address e-mail to dhepner{at}partners.org
The field of anesthesiology has changed dramatically since its beginnings. It began with the need to produce unconsciousness but then incorporated the critical management of the patient’s homeostasis and pain control during and after a surgical procedure. Our expertise in physiology and pharmacology propelled us into the intensive care unit, and our knowledge of neuraxial analgesia and peripheral blocks, in addition to our knowledge in physiology and pharmacology, has taken us into obstetric anesthesia and pain management. The evolution of day surgery and same-day surgery has taken us to preoperative clinics where we interview patients, perform physical examinations, develop anesthetic plans, including adjustment in medications before surgery, and answer patients’ questions. Given these dramatic changes in anesthesiologists’ roles, a few departments across the country changed their names to include words such as "Perioperative Medicine/Perioperative Care," "Critical Care Medicine," and "Pain Management." With expansion into the area of pain management and perioperative care, we have increased opportunities for direct contact with awake patients. This increased patient contact has led to an attempt to emphasize the importance of communication skills. Kopp and Shafer (1) rightly point out that good communication is as important as the knowledge of pharmacokinetics and pharmacodynamics for professional integrity and patient satisfaction. Because contact with patients is usually brief, good communication is extremely important (1).
A number of anesthesiologists spend a majority of their clinical time outside of the operating room. The question that we must now ask ourselves is this: Are we training the new generation of anesthesiologists to be good perioperative physicians and to be professionals with good communication skills?
Merriam-Webster’s Collegiate Dictionary (2) defines a profession as "a calling requiring specialized knowledge and often long and intensive academic preparation;" "professional" is defined as "characterized by or conforming to the technical or ethical standards of a profession and exhibiting a courteous, conscientious, and generally businesslike manner in the workplace"; "professionalism" is characterized as "the conduct, aims, or qualities that characterize or mark a profession or a professional person." Wynia et al. (3) emphasize particular obligations of professionals, including respect for human worth, trustworthiness, and the protection of important values. In other words, a professional ought to represent the highest standards of his or her field while respecting human values. Waisel (4) describes professional obligations of anesthesiologists as including business, patient care, and nonpatient care obligations. Patient care obligations relate to the direct physician-patient interactions. First and foremost, we must earn respect and trust from our patients by listening to them, answering their questions, and explaining anesthetic options and pain management plans. We should perform a thorough history and physical examination, be sympathetic to the patient’s condition, and respect their wishes. We should also be available to answer any questions that may develop from the time of the preoperative visit until surgery and the postoperative period. Nonpatient care obligations include promoting the profession of anesthesiology by training new anesthesiologists and by educating the public about our field (4). In other words, it is our duty to preserve and improve our image and the image of our profession.
In this issue of Anesthesia & Analgesia, Jeske et al. (5) demonstrate that handing business cards preoperatively increases the anesthesiologist’s name recognition, but that this did not have an effect on patient satisfaction. Is name recognition all that we want, even if it doesn’t lead to an increase in patient satisfaction? Does name recognition guarantee that patients know what we do and respect us or our profession? The first question is easier to answer. Being seen as a compassionate professional who performs an excellent job is more important than name recognition per se. The issue of patient satisfaction has already been addressed in an editorial by Klock and Roizen (6) in this journal 5 yr ago. Anesthesia complications in ASA physical status I-II status patients are exceedingly rare, and satisfaction is very high. Even an extraordinarily large number of patients in well-designed studies may not be able to demonstrate a change in patient satisfaction, and more sensitive instruments to measure patient satisfaction may be needed (6).
The second question is what we consider a more relevant issue. Even if name recognition is important, a problem with this study is that the patient could have retained the business card. Perhaps he or she was just copying the anesthesiologist’s name from the card in response to the questionnaire. Even if handing out cards does lead to increased name recognition, we must wonder what to make of this. Name recognition does not guarantee that patients and colleagues are aware of our increased roles as practitioners of perioperative medicine. Becoming more involved in hospital committees, developing preoperative test centers and pain clinics, visible involvement in critical care units and labor floors, and our continued presence in operating rooms will likely demonstrate our increased role to our colleagues. Because patients are usually only exposed to these areas for a short time unless they have complex medical issues, all of our interactions with them may be brief. The few minutes that we spend with a patient before heading to the operating room help build trust and diminish anxiety.
Our role in the preanesthetic clinics is even more intense. As eloquently stated by Klock and Roizen (6), it is what the anesthesiologist does during the preoperative visit that is most important. Klafta and Roizen (7) state that the preoperative visit has six purposes: to assess the patient’s condition (history and physical examination) for anesthesia and surgery, to discuss and explain anesthesia options, to reduce anxiety, to discuss postoperative pain management, to obtain informed consent, and to coordinate patient care among medical professionals in a way that decreases costs and improves outcomes. Many patients will have questions. The handing of a business card not only reaffirms our role as professionals but also lets them know that we are available and willing to entertain questions.
Interestingly, we were not able to find any medical publications in MEDLINE with the search words "business card" and "doctors" or "physicians," but were able to find three references when we changed the search word to "nurse" (8–10). Nurses have had an expanded role in the medical system because of their increased involvement with patient care. Their handing of business cards may be part of the reason of their success, or, more likely, it is emblematic of their accessibility to patients. We strongly believe that knowledge of our profession as a whole, and of what we do, is much more important than name recognition per se.
We must also stress other, nonverbal forms of communication. We can dress as professionals when we are having direct patient contact outside of the operating room, and wear white coats and name tags. Physician dress is important to patients and colleagues and gives us a professional appearance (11). Manners, habits, and interpersonal skills are also other forms of communication (1). The handing of a business card is another form of communication. If we want to improve our image, and want to continue our expanded roles in the medical system, then we must act as professionals and be sure that the physicians in training are educated in verbal and nonverbal forms of communication. Poor communication has also been associated with increased litigious intentions and failure of communication has been associated with litigation (12,13). It is no longer acceptable to think "I went into anesthesia because I don’t want to talk with patients." Excellent communication skills are as essential for the short period of time before induction of anesthesia as they are for our extended roles outside of the operating room.
Saidman (14), in the 1994 Rovenstine lecture, mentioned that what is done is more important than who does it. The handing of business cards, even if it does not lead to increased patient satisfaction, may reaffirm our roles as professional perioperative physicians and let patients and other physicians know that we are indeed serious and committed to our expanded roles. If we are truly committed to good communication, we will make sure that patients feel comfortable using the information on the card and will contact us with questions.
Even as we borrow traditional business tactics such as handing out business cards, we must not lose sight of the differences between business and medicine. In her editorial "Bringing market medicine to professional account," Emanuel (15) cautions about the mutually dependent nature of medicine and business. She further states that all business activities in medical care are subject to the same professional standards, and that professionalism requires caution on profit-seeking activities. Patients come to us because they trust us; at some point they become dependent on us. Professionalism requires that we provide superb clinical care regardless of the business aspect of our profession. Others have made it clear that professional medical associations’ influence in making changes in health care depend on patient’s trust and support (16). Only if patients know our roles, and only if we work in the patient’s interest, will we be able to make an impact on the health care delivery system.
Acknowledgments
The authors thank Eleanor R. Menzin, MD and Simon Gelman, MD for their insightful comments and suggestions and for a careful review of the editorial.
References
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