Gabriel M. Gurman, Chief Editor
The career of any physician is marked by a series of stages, one naturally coming after the other. At the beginning the young doctor learns a lot, practices a lot, and tries to prove that they are fit for the selected domain. Later on, as a specialist, the mature physician is very interested in showing their abilities in dealing with the routine work, but at the same time capable of taking care of difficult, unusual cases.
The time for teaching comes soon after. A physician teaches; this is a well-accepted axiom, and its origin comes from the simple fact that medicine implies permanent learning activity in order to keep updated with everything that is new and worthwhile to retain and apply in treating patients. We cannot afford to stay behind progress and innovation, since our patients’ wellbeing depends in large measure on our efforts to keep ourselves updated.
But what could be said about a fourth stage, whose existence is almost unnoticed, but does, for sure, show up and keeps some of us still busy and interested in the new developments of our profession? I am speaking about the stage in which the retired physician is still active and interested in being involved in what is happening in the domain that was theirs for tens of years.
This fourth stage comes after the aging physician gradually decreases their involvement in clinical routine and even in research. Fortunately, it leaves them with one of the most important fields of medical activity: teaching.
I must confess that all the above present a correct image of my own career, since I have gradually passed all three first stages and am now in the fourth one, one that keeps me active and busy, especially in the field of teaching and education.
But like in any domain, the art of teaching changes with time and new methods and techniques prove to be useful and need to be taken very seriously into consideration. Today simulation, for instance, has become a very important tool in the field of teaching skills and offers the young physician a unique opportunity to train and get experience long before they would touch the first patient. This permanent change in technology is well-known and recognized by all those involved in the process of teaching.
In the last years I became aware of many other topics of teaching, somehow neglected by the average tutor and having only a peripheral interest for both the young physician and their educator.
So let’s start with a question which is, apparently, too easy to be answered: What do we teach the young resident in anaesthesiology? I am sure that the vast majority of our readers would quickly build a list of topics that would include: clinical judgment, scientific approach, professional curiosity, discipline, team behaviour, ability to cope with changing situations. If one would add to this list manual skills, it seems that we are covering the main aspects of education in anaesthesiology. This approach is based on the idea that the anaesthesiologist’s work must focus on both the scientific and practical aspects of this profession, but forgetting some other components of a physician’s routine work, such as communication with the patient or the ethical side of this specialty.
In recent years, people speak (and write) extensively about one subject never touched during ‘my time’: the professionalism in anaesthesiology. It seems that this is one of the topics for which the physician is expected to be accountable when dealing with their patient.
So, what is it about? Webster’s dictionary defines professionalism as ‘the conduct, aims, or qualities that characterize or mark a profession or a professional person’. There is no way to understand the above sentence without trying to go further and see what we could find beyond this rather dry and abstract definition.
Years ago a group of leading Canadian anaesthesiologists from Edmonton, Alberta, decided to define the patterns of professionalism in anaesthesiology by identifying qualities in three distinct areas: professionalism-humanistic, personal development, and anaesthesiology meta-competencies (Medical Education 2005;39:769). Surprisingly or not, they succeeded in building a long list of attributes that must be taught and developed during residency and even after reaching professional independence. To present each of the qualities included in this interesting list would be beyond the aim of this editorial.
I would like just to bring to the attention of our readers two of the items discussed in the literature in recent years. The first one refers to the need for communication with the patient. I wonder how many times your resident was told about the beneficial effects of a good talk with the patient in the preprocedural period? How many of our young colleagues are aware of the fact that the anaesthesiologist-patient communication could have the following positive effects (a list taken from a very good review by Kopp and Shafer, Anesthesiology 2000;93(2):548-55): anxiolysis, sedation, amnesia, control of gastric secretion, control of salivation, attenuation of the autonomic nervous system effects, reduction in total anaesthesia requirements?
The idea of a good and personal communication between the anaesthesiologist and their patient sounds feasible, but obstacles are present: the production pressure (discussed not only once in this rubric), the difficulty of having a talk with an emergent or urgent patient, or the fact that much too often the anaesthesiologist in charge of the preoperative evaluation is not the same one the patient would meet in the operating room.
But one thing is sure: the anaesthesiologist could not be excepted from the duty of using communication with the patient like any other therapeutic tool. They are first of all a physician, and the primordial role of the physician is to know their patient and to adjust the proposed management not only to the patient’s disease but also to their personality and expectations. This is what Kopp and Shafer call communicating professionalism. Communication is an art, and like any art it has to be taught and learned. It is our obligation, as teachers and tutors.
Out of the many patterns of the anaesthesiologist’s positive characteristics, presented by the Canadian colleagues, I would like to select a second one, namely the ability to accept criticism appropriately, a feature of personal development.
We are not psychologists and very few of the people I have met in my career possessed the gift of correct ‘diagnosis’ of one’s personality. But, gradually, we accumulate experience regarding the ability to recognize those who are unable to see criticism as a tool for mending mistakes and modifying a wrong routine or habit. Not too seldom one feels that two words are added to the famous saying ‘Nobody is perfect’: but me! Educating a young physician in this direction seems to be a must. We commit mistakes, in the vast majority of cases not because of negligence or a superficial approach to the patient’s condition, but because one patient does not behave exactly like the next one, and because we do not know, yet, everything about our patient and because we do not possess, yet, all the means to solve all the problems.
Clinical experience and positive criticism of our peers could reduce the percentage and magnitude of our errors. But in order to get this help, one has to be open to criticism. This demand might come in contradiction with our ego, but modesty and respect for others’ opinions could tame the tendency to put our own existence in front of everything and everybody.
Eventually, everything is a question of attitudes, a domain much more difficult to adjust than accumulation of knowledge and skills.
Unfortunately, very few of us, the teachers, understand the vital need to address this part of the needed education and to show our younger colleagues the right direction towards improving attitudes.
However, possessing all those qualities included in the definition of professionalism is a goal, and in order to reach it continuous work and persuasion are needed. In contrast with what many might think, professional personality is not only a genetic pattern; it can be modified and adjusted, for the benefit not only of our patients, but also for our own sake.
So, to conclude, what does it mean to be a successful anaesthesiologist? In my opinion that definition has to include one single characteristic: the continuous, permanent search for improving one’s professional activity and achievements, and not forgetting even for one second that we are healers and that we take care of humans who need to be treated as such.