The results of this survey of Jordanian patients admitted for elective surgery in a teaching hospital about their perception of anaesthetists and their roles, showed a mixture of appreciation and misconception. Patients were aware of the standalone nature of anesthetic practice from the surgical team and were also informed that the anaesthetist is committed to his patient in the operating theatre. Furthermore, the importance assumed by most of our patients to the role of anaesthetists was equal to that of surgeon by 71.5% of them. However, only 37% of them recognized the anaesthetist as a specialized doctor. Furthermore, the anaesthetist was thought to be a technician by an even higher percentage of patients (41%). This misconception may be because anesthetic services in Jordan used to be provided mainly by anesthesia technicians in the past. The scarcity of anaesthetists in the country mandated this level of qualifications until the mid-eighties of the last century. At that time, regulations were set by the ministry of health, which limited the provision of anesthetic care to physician anaesthetists. Unfortunately, there are no previous national baseline values to compare our results with. However, it is apparent, after about three and half decades, that the rise in the public awareness of the professional identity of the anaesthetist is slow. This slow progress of awareness about anaesthetists was observed even in developed countries at some point and reflected deficient perioperative teaching and communication on the side of anaesthetists about their practice.4
Our patients’ awareness of the different roles of the anaesthetist is consistent with their perception of his qualifications. This consistency was most apparent in the awareness results of the intraoperative roles of the anaesthetist, Table 2. Here, patients voted most for the roles that are mainly concerned with the sleep process, while more medical roles, like fluid management, blood transfusion, and administration of other necessary drugs, were perceived only poorly. On the other hand, the medical roles of preoperative patient assessment and postoperative management of complications were also considered least by patients to be roles of anaesthetists. Our results about the physician status of anaesthetists are close to those reported in previous studies from different countries in the developing world.8,9,10,11
Compared to other perioperative and outside-theatre roles, the preoperative duties of anaesthetists were the most recognized duties by our patients, with a knowledge score of 65.1%, Table 3. A possible explanation could be that the patient’s knowledge about the roles of anaesthetists was likely obtained by witnessing rather than education. The total loss of consciousness during general anesthesia and the residual effects of anesthetic drugs in the recovery room will deprive patients of this resource of learning.
Age was the only demographic factor significantly affecting our patients’ level of awareness of the roles of anaesthetists, Table 4. This finding is intriguing as older patients are more familiar with the older system of anaesthetist qualifications and roles. However, once again, if the practice of anesthesia was not brought to patient’s awareness through ongoing education and proper role modelling, patients will end up with the implicit type of learning through exposure to the different sources of information like friends, media, and observation during previous surgical experiences. This implicit type of learning is believed to be preserved with healthy aging, and older patients will have the privilege of higher exposure to information through this type of learning.12 The active role of educating patients about this specialty seems to be deficient so far among anaesthetists in our country and unfortunately even in teaching hospitals.
Regardless of their level of education, there is always a desire amongst patients to know, and efforts in this regard are mandatory to increase awareness of the specialty.13,14 The benefits of educating patients about anesthesia and what to expect from their anaesthetists are multiple. Patients’ fear from the loss of control over their own bodies during anesthesia can negatively affect their perioperative course of management to the extent that they may choose to cancel their surgeries. Enlightening patients with the details of their perioperative anesthetic care in terms of personnel and practice, will alleviate much of their anxiety and make them feel better in control over this part of their hospital experience.15,16 On the other hand, anaesthetists will be able to build rapport with their patients during their preoperative physician-patient encounters.4,17 This rapport fosters the trust and confidence of patients in their anaesthetists and will help improve the poor public image of the practice of anesthesia and even reduce incidence of malpractice litigations.4,18 The patients’ perception and knowledge of the practice of anesthesia was shown to be improved by active patient education endeavors.15 This education can take multiple forms which include: preoperative assessment clinics, informative preoperative visits, use of educational videos, use of public media, educating other health professionals about anesthesia, and getting anaesthetists involved in administrative hospital committees.4,19,20,21
Our study results gave an idea about the current state of patients’ perception of anesthesia and anaesthetists in Jordan. We believe that results represent an addition to the medical literature from this part of the world in this field and can be used as a reference for any future studies in this regard.