Gabriel M. Gurman, MD
I must confess that although this topic interests me a lot, and not only from yesterday or yesteryear, the decision to discuss it in our Newsletter came out of a recent article published in September 2016 in the prestigious English newspaper The Guardian and signed “Anonymous”. Actually its title hardly covers the content. It says “The secret life of an anaesthetist: if the surgeons are the blood, we are the brains”, but it rather deals with the discrepancy between our huge responsibility in the operating room (OR) and outside it and the profession’s image in the public’s eyes. Here is one of the sentences: “You have to get used to being invisible as an anaesthetist. A large percentage of the public has no idea that we’re medically qualified”. And another one: “Patients always remember the name of their surgeon, never that of their anaesthetist”.
So, this is the subject of the anonymous writer and I have a strong feeling that he/she is right. Once upon a time I called the anaesthesiologist the backstage director, the professional who takes care of everything, who in a lot of situations leads the OR team, who assures that everything is prepared in order to secure the patient’s homeostasis during surgery and the success of the operation, but exactly as in the case of a play (or a show) director, he would never be called on the scene to get the applause of the public.
I have no doubt that this is the reality in many of our hospitals, all over the continent.
During my first four years as an anaesthesiologist in Israel, working all the time in the OR, I was never approached by a patient’s family, neither for enquiring about his/her condition, nor to thank me for the job done. But when I moved my activity, four out of five days of the week, to the intensive care unit (ICU) the contact with the families and very often with the patient him/herself, became permanent and encouraging. Nothing about this special kind of feeling is expressed in the cited article. We, too, are human beings and we, too, need other people’s appreciation and recognition of our merits.
But my question is a double one. First, does this situation disturb us in a way that would interfere with our daily activity, and then, if yes, what do we have to do in order to find a remedy to this rather sad reality?
The answer to the first question is not an easy one. As professionals, we have our own satisfaction, actually on an almost daily basis. Since today there is no absolute contraindication to put a patient on the operating table, we take care of very serious sick surgical patients, and in the vast majority of cases we do succeed not only to keep the patient alive, but also to stabilize his/her condition and give a real chance for the surgical act to succeed.
Almost one third of our routine activity takes place outside the OR: in the ICUs, pain clinics, outpatient anaesthesia clinics, sedation for gastroenterological and radiological invasive procedures, and much too often we are called to take care of small kids who are supposed to pass a painful non-surgical procedure.
So, once back home, in the late hours of the day, each of us can summarize, with a lot of satisfaction, his/her activity and reach the conclusion that a lot of patients owe their life, in the real sense of the word, to our professional abilities, experience, and skills.
In many places of our old continent, the anaesthesiologists are fairly financially compensated for their intense and professional activity, in a way that permits a good life for him and his family.
If so, where is the problem? In other words, who cares for the fact that once awake and outside the OR, the average patient does not remember his or her anaesthesiologist’s name?
So, how much does it disturb us and our profession? How much does affect us is the sad reality that a large percentage of the population does not know, yet, that we are doctors, and even more does not understand the simple fact that we are with and near the surgical patient, in the OR, long before the surgeon and even more after the last skin suture?
Once again, the answer could be yes and no.
No, this reality does not have to disturb us, because in every single profession where the contact with the public is obvious, there is a real danger that the disappointment related to public ignorance is just around the corner. Nobody could go on and perform his/her profession out of permanent frustration. We take care of our patients not because we expect the public’s applause, but because we are completely dedicated to our profession and to our patients’ wellbeing.
But yes, this situation is supposed to worry us, first of all because it could easily influence the decision of young colleagues to choose our profession.
I have no doubt that public recognition is part of a long list of incentives that could influence a medical graduate’s decision regarding his future specialty. Needless to say, our profession is one of the most demanding among medical specialties, because of hard work, the need to achieve excellent skills and knowledge, and the high degree of responsibility. A correct and positive appreciation and a respectful position in the medical community could represent a fair compensation for what we sacrifice every single day and night for the benefit of our patients. One cannot forget that love for the profession comes much later than the decision to choose it among so many other possibilities and professional attractions. This is the reason why, in order to attract a young doctor, he/she must know from the very beginning that the proposed domain is recognized and appreciated by large layers of the population.
The second reason, not less important, for the need to achieve public recognition and appreciation is related to the attitude of the patients and families towards the professional opinion of the anaesthesiologist. Once the average patient and family would understand the fact that the anaesthesiologist is a highly qualified physician, who accumulated during his/her career vast experience and skills, his/her advise would be seriously taken into consideration. As long as the surgeon’s opinion is considered unique and absolute, there would not be a place to correctly judge the anaesthesiologist’s advice, which sometimes (who knows it better than us?!) could be different from that of the primary care doctor.
This point is not at all a question of hubris! With few exceptions, we see our patients very early on their way to the OR and too often we might decide on what has to be done, before surgery, in order to improve patient’s chance to successfully pass the operation. Our recommendations are supposed to be followed by the patient, but with the sole condition that he/she is aware of our professional value.
All the above implies that things need to be done in order to mend the situation. A lot depends on us.
We must be alert to public opinion and the impact the news from the OR has on it. Leaving the newspaper columns and radio and TV news only for bad events would not contribute to the image the profession has in the public’s eyes. Successful cases, new techniques, improvement of anaesthesia morbidity rate, the increase of patient postoperative satisfaction because of the proper management of surgical pain, these are many of the topics to be “infiltrated” in the media, thus creating an adequate atmosphere in the favour of the profession.
Finally, the medical community has to accept the fact that although we serve other professionals, anaesthesiology is a completely independent specialty, with its own fields of interest, that we treat our own patients in the pain clinics and ICUs, and that we practice medicine like any other medical professional.
Nobody would expect quick results. And nobody could expect that this job would be done by others. But it has to be started, even from the scratch.
Because if we do not make the future, the future will make us.
Or, as advised in Alice in Wonderland: “Begin at the beginning, the king said bravely, and go till you come to the end and only then stop!”