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ECONOMICS AND HEALTH SYSTEMS RESEARCH

The Impact of Business Cards on Physician Recognition After General Anesthesia

Department of Anesthesia and Intensive Care Medicine and *Department of PsychiatryThe Leopold Franzens University of Innsbruck, Innsbruck, Austria

Address correspondence and reprint requests to A. Benzer, MD, Professor, DEAA, Department of Anesthesia and Intensive Care Medicine, The Leopold Franzens University of Innsbruck, A-6020 Innsbruck, Anichstr. 35, Austria. Address e-mail to arnulf.benzer{at}uibk.ac.at

	Abstract

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Despite their contribution to overall perioperative treatment of patients, anesthesiologists often remain in anonymity. We evaluated the impact of business cards on physician recognition after general anesthesia. Using a questionnaire, 441 patients were interviewed for recall of the anesthesiologist’s name, the surgeon’s name, and their overall satisfaction with anesthetic care 6 wk after undergoing surgery during general anesthesia. Of these patients, 155 had and 137 had not randomly received a business card during the preoperative visit, with another 149 patients serving as a control group. Business card recipients responded significantly more frequently than did nonrecipients or patients from the control group (65.8% vs 54.7% vs 53%), with recall of the anesthesiologist’s name being significantly more frequent in the Business Card Recipient group (51.5% vs 14.3% vs 11.4%). Patient satisfaction with anesthetic care and recall of the surgeon’s name were similar in all groups. The use of a simple tool such as a business card can indeed produce a measurable positive change in physician recognition on the part of the patient.

IMPLICATIONS: Anesthesiologists often remain anonymous in everyday clinical practice. Handing a business card to the patient during the preoperative visit increased the postoperative recall of the anesthesiolgist’s name from 11% to 51%.

	Introduction

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The lack of public understanding of the anesthesiologist’s role in medical care and the lack of the anesthesiologist’s identity in the individual patient-doctor relationship are common problems and raise an issue that should not be overlooked with regard to developing public awareness for our profession (1). The patient’s desire to meet the anesthesiologist preoperatively (2), the impact of the anesthesiologist’s appearance on the patient’s perception of the preoperative visit (3), and the overall value of the preoperative and postoperative visit have been repeatedly investigated (4–6). We sought to test the hypothesis that handing a business card to the patient during the preoperative visit can influence the rate of postoperative recall of the anesthesiologist’s name as compared with traditional preoperative visits.

	Methods

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After approval by the local University Ethics Committee 450 patients (aged 18–65 yr, ASA physical status I-III, anticipated duration of surgery <2.5 h) were enrolled in this prospective study at Innsbruck University Hospital (30,000 anesthetics/yr). Neither the 26 anesthesiologists involved in the study nor the patients were informed that a questionnaire would be mailed to the patients 6 wk after anesthesia. Distribution of business cards was primarily part of a quality-improvement project. The study population consisted of business card recipients and business card nonrecipients. To detect a study-dependent bias because of a change in behavior of the anesthesiologists participating in the study, a third group (control group) of patients was chosen from patients who met inclusion criteria but who were treated by anesthesiologists not involved in the actual study.

In each group the patient saw the same anesthesiologist three times: on the ward 1 day prior to surgery (preoperative visit), on the day of surgery (in the operating room), and on the day after surgery (postoperative visit). The structure of the routine preoperative interview included evaluation of the patient’s medical history, physical examination, and information for the patient on the planned anesthetic management, potential anesthetic complications, perioperative pain management, and various questions posed by the patient himself. At the end of the preoperative visit the anesthesiologist opened a sealed envelope that (randomly) contained or did not contain a business card and handed the business card (see Appendix) to the patient if the envelope contained one.

Six weeks after surgery each patient received a questionnaire by mail asking him to name his anesthesiologist and his surgeon. Additionally a visual-analog scale (0 - 100 mm = 0% - 100% = maximal dissatisfaction –maximal satisfaction) was used for assessment of patient satisfaction with anesthetic care.

The software package SPSS^® was used for statistical analysis. The ² test was used, with P 0.05 considered statistically significant. Data are presented as mean ± SD.

	Results

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A total of 441 patients (227 female, 214 male, mean age: 39.7 ± 11.7 yr; mean duration of operation: 58.6 ± 24.5 min) completed the study. Patients receiving a business card responded significantly more frequently to the questionnaire and significantly more frequently were able to name the anesthesiologist as compared with the other groups. Recall of the surgeon’s name was similar in all three groups. Assessment of patient satisfaction with anesthetic care also revealed no difference among groups (Table 1).

	Discussion

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Business cards are an important part of conveying a professional image; they are especially helpful as a supplement to verbal communication especially when the communication takes place under unfavorable conditions (e.g., emotional stress, strange surroundings, time pressure). They contain information that is often difficult to remember, abstract or technical in nature (for example, name, professional status, telephone numbers, addresses), the proper conveying of which would often occur at the price of the actual communication. If anesthesiologists want to counteract the patient’s lack of knowledge about their personal identity and the anonymity of their work, they need to take advantage of the most promising time for establishing a close physician-patient contact, namely, the preoperative visit. Interpersonal communication presumes that the participating parties identify themselves to each other and know each other’s names.

The anesthesiological literature contains very little on the emotional relationship and the familiarity between physician and patient (7). When investigating the media images of medical professionals Krantzler (8) found a shift in doctors’ image away from the white coat and stethoscope towards science in action and high tech. In the already technically oriented field of anesthesia with its brief patient contacts, this shift in image may contribute to the further depersonalization and lack of recognition of anesthesiologists.

The medical value of the preoperative, as well as the postoperative, visit has been viewed controversially. Some studies found that in addition to its medico-legal importance the premedication visit also provides measurable medical benefits (5,9,10), whereas other authors found it to be purely a response to patient wishes (4). Farnill (2) showed that the patient has a great desire to see the anesthesiologist preoperatively, while Sanders et al. (3) found that the anesthesiologist’s appearance has no influence on the impression made on the patient. Even a second or third postoperative visit did not improve the rate of recognition of the anesthesiologist’s name (6).

The economic constraints of recent years (one-day surgery, shortening of inpatient time) further restrict the anesthesiologist’s opportunities to establish a closer relationship with the patient. In the study by Zvara et al. (6) only 8.3% of patients were attended by the same anesthesiologist at the preoperative visit, the subsequent anesthesia, and the postoperative visit. This possibly reflects the real situation of resource optimization in modern hospital routine, where anesthesiologists are often pre-, intra-, and postoperatively rotated and assigned as needed in their role of service provider for the patient and the surgeon. It is also general clinical knowledge that because of their more frequent and longer-term contacts with patients (e.g., preoperative examination, admission of patient to surgical ward, postoperative care), surgeons have better opportunities to provide their patients with the information they desire and thus to establish a closer relationship with them. This was also demonstrated by our study in which the recall rate of the surgeon’s name was much more frequent than that of the anesthesiologist’s name.

A study recently conducted by Myles et al. (11) on postanesthetic patient satisfaction showed an overall satisfaction level of 96.8%, a figure that is not easy to improve on. The study by Zvara et al. (6) also found a similar (frequent) rate of patient satisfaction independent of the number of postoperative visits. In our study a business card presented to patients was not seen to further increase patient satisfaction. Because there is no "gold standard" for assessing patient satisfaction, we investigated this variable only as a secondary issue, namely to rate it in comparison with other studies.

In today’s society health care has become a business, with patients now being clients and health care consumers. As stated by Klock and Roizen (12), it is what the anesthesiologist does during the preoperative workup, when the patients are more likely to have questions and be more anxious, that counts most. If the patient is to be given additional information on the type of medical care we provide, the preoperative visit is an ideal setting. For this reason it is reassuring that in our study patient satisfaction, even in those who received no business card, remained high. From the anesthesiologist’s standpoint, however, it is important that a business card permits him/her to leave anonymity and to present himself/herself as a recognized, competent member of the medical community.

	Appendix

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Appendix

	References

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1. Wetchler BV. They don‘t know who we are. American Society of Anesthesiologists Newsletter 1994; 58: 2–4.
2. Farnill D. Patients desire for information about anaesthesia: Australian attitudes. Anaesthesia 1993; 48: 162–4.[Medline]
3. Sanders LD, Gildersleve CD, Rees LT, White M. The impact of the appearance of the anaesthetist on the patient’s perception of the pre-operative visit. Anaesthesia 1991; 46: 1056–8.[Medline]
4. Nightingale JJ, Lack JA, Stubbing JF, Reed J. The preoperative anaesthetic visit: its value to the patient and the anaesthetist. Anaesthesia 1992; 47: 801–3.[Medline]
5. Egbert LD, Battit GE, Turndorf H, Beecher HK. The value of the preoperative visit by an anaesthetist. JAMA 1963; 185: 553–5.
6. Zvara DA, Nelson JM, Brooker RF, et al. The importance of the postoperative anesthetic visit: do repeated visits improve patient satisfaction or physician recognition? Anesth Analg 1996; 83: 793–7.[Abstract]
7. Kopp VJ, Shafer A. Anesthesiologists and perioperative communication. Anesthesiology 2000; 93: 548–55.[Web of Science][Medline]
8. Krantzler NJ. Media images of physicians and nurses in the United States. Soc Sci Med 1986; 22: 933–52.
9. Elsass P, Eikard B, Junge J, et al. Psychological effect of detailed preanesthetic information. Acta Anaesthesiol Scand 1987; 31: 579–83.[Medline]
10. Leigh JM, Walker J, Janaganathan P. Effect of preoperative anaesthetic visit on anxiety. BMJ 1977; 2: 987–9.
11. Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 2000; 84: 6–10.[Abstract/Free Full Text]
12. Klock PA, Roizen MF. More or better - educating the patient about the anesthesiologist’s role as perioperative physician. Anesth Analg 1996; 83: 671–2.[Web of Science][Medline]

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