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Presentatión

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.

Table of contents

Foreword

SECTION I. A PHILOSOPHICAL PERSPECTIVE OF ANESTHESIA (1981)

1. Quality vs. quantity of patient contact. J. Antonio Aldrete
2. Thoughts on safety and comfort. Bento V. Goncalves
3. The anesthesiologist: physiologist, pharmacologist, technician or physician? Robert W. Virtue
4. Preanesthetic visit vs. preanesthetic evaluation. Miguel Colón–Morales
5. Defusing a highly charged atmosphere. J. Antonio Aldrete
6. The post–anesthetic visit: is it practical? Alberto E. Lugo 

   SECTION II. ANESTHESIOLOGIST–PATIENT RAPPORT (1982) 

7. Improving communication with our patients. J. Antonio Aldrete
8. The anesthesiologist’s image by means of communication. J. Antonio Aldrete
9. What do our anesthetized patients hear? David Halfen
10. Adjuvants to supportive conversation. J. Antonio Aldrete
11. Hearing without listening. Frank Guerra 

    SECTION III. HUMAN FACTORS APPLIED IN ANESTHESIA (1983) 

12. Anesthesia technology and the human factor. J. Antonio Aldrete
13. The anesthesiologist ministering to the heart, the mind and everything. Frank Guerra
14. The human factor and the cancer patient. J. Antonio Aldrete
15. The human factor in obstetric anesthesia. Stephen H. Jackson
16. The personal touch. J. Antonio Aldrete 

    SECTION IV. A SELF–SCRUTINY OF OUR SPECIALTY (1984)

17. An introspective look at ourselves. Thomas T. McGranahan
18. The silent horseshoe counter. J. Antonio Aldrete
19. What you do not want done to yourself, do not do to others. J. Antonio Aldrete
20. Opportune and favorable interventions. J. Antonio Aldrete
21. Getting caught in the alphabet soup. J. Antonio Aldrete 

    SECTION V. CONTROVERSIES OF ETHICS IN ANESTHESIA (1985)

22. Medical ethics and the anesthesiologist. David Eric Lees
23. The primacy of the patient’s wish. David Eric Lees
24. Anesthesiology: saving or taking a life? David Eric Lees
25. Death in dignity. J. Antonio Aldrete
26. Profit versus compassion. J. Antonio Aldrete
27. Bioethics, an ever–changing and accommodating discipline. J. Antonio Aldrete 

    SECTION VI. EMOTIONS, FRIENDS AND THE SOUL (2003) 

28. Firm confidence vs. authoritarian arrogance. J. Antonio Aldrete
29. Informed consent: sharing responsibility. J. Antonio Aldrete
30. Emotional reactions to anesthesia and surgery. J. Antonio Aldrete
31. Those patients in the transplant unit. J. Antonio Aldrete
32. Anesthesia and the soul. J. Antonio Aldrete, M.D., M.S. & Amos J. Wright
33. Walking unknown paths toward a milestone. J. Antonio Aldrete
34. The surgical act. Joaquín S. AldreteAlphabetical index