The human factor of anesthesia and patient care
Aldrete, José Antonio
Aldrete, José Antonio
While interviewing numerous medical students contemplating anesthesiology as their future specialty, one definite concern frequently surfaces.
In their abstract idealism they expressed, in one way or another, a genuine preoccupation for the amount of patient contact afforded by anesthesiologists in their daily practice. Though the acute care and prompt problem solving of our specialty attracted them, what they have seen and/or heard in their experience at medical school regarding anesthesiologists being in contact only with sleeping patients, caused them alarm. That image hangs on us, justifiably or not, but it does and must be changed.
In reality, our contact with patients, though perhaps shorter in duration when compared to other specialties, occurs at a time crucial for our patients, at a moment when major events in their lives are about to happen.
When we first see them in the preanesthetic interview they are concerned about a number of unknowns. Do they have cancer? Are they going to be able to walk? Is their sexual activity going to change? Are they going to be left without a breast, a leg, a hand, etc.? How much longer are they going to live? Will they survive the operation? Only to mention a few of the more frequent worries that surgical patients may have the day before their operation. Our visit must provide assurance and confidence and not produce more worries. This is indeed a precious time when we may alleviate some of the patient’s concerns about their operative and anesthetic experiences. What better time to explain our role in watching over their vital functions, to explain the careful administration of potent medications used during anesthesia, to warn over possible complications, to emphasize how our technique may ameliorate the immediate postoperative pain, etc.
It may be a short contact, but if properly conducted, that interview may play not only a valuable support of the patient’s emotional status but also an informational activity of what we do and how we do it, at a moment when the patient’s attention is all ours. This can again be extended during our encounter with them in the operating room; there, we have from 5 to 30 minutes, depending on the preparation for the operative procedure. While performing our functions we can literally “chat” with them, explaining what we do and why we do it and then they will be more willing to accept the pain of a needle stick, the removal of a gown, the discomfort of lying on a hard operating table. But in addition, we can inquire about their sleep during the last night, their supper and other niceties to which the patient has shown interest or attraction; there again, their attention is ours, and is ours to cultivate.
Finally, let’s make the post–anesthetic visit more than a “hi” meeting; let’s make it a real visit. While inquiring about problems related to their surgery and anesthesia, we can add some personal touches to the conversation so as to make the patient feel that we truly know each other.
So, there is my answer to the inquiring potential resident candidates; the contact with our patients may be brief (as measured by units of time), but it is in crucial moments of the patient’s life, dealing with life and death matters; thus, we can make it one for them to remember and appreciate, if we just take the time.
The preanesthetic interview, the O.R. encounter and the postanesthetic visit(s) are what we make of them, as short or as lengthy as we wish; as important or as irrelevant as we want to think they are.
SECTION I. A PHILOSOPHICAL PERSPECTIVE OF ANESTHESIA (1981)
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