Effects of choice of anaesthesia on the patient’s image of the anaesthesiologist
*Magdalena Kwiatosz-Muc1,2, Witold Lesiuk1
1Department of Anaesthesiological Nursing and Intensive Medical Care, Medical University of Lublin
21st Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin
Background. The social status of physicians has been traditionally high in Poland; over recent years, we have noticed increased patient expectations in relation to the newest technology and the highest possible competence. The patient’s image of medical personnel may influence his or her opinion about the quality of the service and of the medical centre. At the same time, we have noticed signs of decreasing trust, and an increased number of legal claims against doctors. The purpose of this study was to compare the image of anaesthesiologists, as perceived by patients who underwent Caesarean section either with general or spinal anaesthesia.
Methods. Five hundred and thirteen parturients were asked to complete a questionnaire about their view of the attending anaesthesiologist, assessing the doctor’s attitude with 7-degree visual-analogue scale.
Results. Four hundred and twelve valid forms were returned. Women who received spinal anaesthesia rated their anaesthesiologist higher than those who had general anaesthesia. Among the most important factors that influenced their opinion were: competence, calmness, trustfulness, accurate and detailed information, patience and kindness. Feelings of intimacy and privacy were less important, but the length of the preoperative visit was found to be a relevant factor.
Anaesthesiologists providing spinal anaesthesia were rated higher, probably because they were spending more time with awake patients than those who had chosen general anaesthesia. The latter may also have been in a hurry, because of co-existing emergencies.
Conclusions. We conclude that patients’ satisfaction depends mainly on the time spent with their doctors before anaesthesia and during the procedure. Regional anaesthesia may increase the patient’s trust and satisfaction, when compared with general anaesthesia.
A physician is perceived by the society as the most important health care provider . Many authors emphasize the significance of professionalism and friendliness of physicians towards patients [2, 3], who want to be diagnosed and treated with the use of the newest technology and by the medical personnel of the highest qualifications. The physician’s attitude and behaviour may influence the patient’s opinions about the service he/she has received and about the health care centre they have attended.
The physician’s image is particularly important in the period of social and political changes, decreasing trust in the medical profession and increasingly high numbers of legal claims regarding the lack of commitment of physicians in their duties. Such changes are observed amongst both the Poles and Americans. The latter declare lower recognition of the medical profession; nevertheless, in the USA this profession has been ranked among the most prestigious ones since the 70-ties .
The aim of the present study was to compare the image of anaesthetist among women who underwent general and subarachnoid anaesthesia for Caesarean section. Moreover, the opinions of the two groups about anaesthesiological care were compared and possible relations between the opinions about the anaesthetist versus anaesthetic care were determined.
The authors` questionnaire was used, which the patients received on the second post-operative day. The attending anaesthetist was not involved in the distribution of questionnaires.
The answers to questions about the anaesthetist and emotions experienced by patients were assessed according to the 7-degree visual analogue scale containing adjectives of opposite meaning. For instance, in the question about traits of the attending anaesthetist, one of the pairs was ‘competent’ – ‘incompetent’. When number 1 was circled, the anaesthesiologist was found highly competent; 7 meant ‘completely incompetent’ whereas 4 denoted a neutral opinion.
Based on the 5-degree Likert scale, the opinions regarding the satisfaction with anaesthesiological care were grouped according to the following answers: ‘definitely yes’, ‘rather yes’ ‘I don`t know’( or ‘I am not sure’), ‘rather not, ‘definitely not’.
The results were statistically analysed. The Student’s t, Cochran-Cox, and χ2 test of independence were applied. The Pearson’s coefficient of correlation and Spearman’s rank correlations coefficient were used for analysis of correlation. P<0.05 was considered statistically significant.
The study involved 513 women; 412 fully completed and properly answered questionnaires were returned; based on them, the study population was divided into two groups: G – patients undergoing general anaesthesia (n=261) and S – patients receiving subarachnoid anaesthesia (n=151).
The opinions about the attending anaesthetist differed significantly between the groups. The patients with subarachnoid anaesthesia perceived the anaesthetist as more trusty, friendly, polite and competent compared to women who underwent general anaesthesia. For the pair of adjectives ‘trustworthy’ – ‘untrustworthy’, the mean score in group G was 2.181.77 whereas in group S 1.771.2 (p=0.006). For ‘friendly ‘ – unfriendly’, the score was 2.041.50 and 1.581.20, respectively (p=0.002); for ’polite’ – ‘impolite’ – 1.881.47 and 1.521.11 (p=0.01), and for ‘competent’ – ‘incompetent’ – 2.111.57 and 1.601.08, respectively (p=0.000).
There was a correlation found between the opinion about the anaesthetist and satisfaction with anaesthetic care. The more trustworthy, friendly, polite and competent the anaesthetist was, the more satisfied with anaesthetic care the respondents were (p <0.05) (Fig. 1).
In both groups, the most important features of the anaesthetist, a member of the operating theatre team, were his professionalism, followed by self-control, trustfulness, detailed and accurate information, patience and politeness. Feelings of intimacy and privacy were found by respondents less important (Fig. 2).
In both groups, the answers about feeling tranquil or anxious, relaxed or tense, calm or nervous during pre-operative visits were comparable. The respondents were rather tranquil, not tense or nervous, but they were not relaxed or calm. The group G patients more often stressed poor reassurance (3.291.55) or concentration (3.171.56) compared to the group S patients (2.661.97 and 2.481.51, respectively) (p=0.000) (Fig. 3).
The significant intergroup differences were observed as for the length of pre-operative visits. The patients who received general anaesthesia almost three times more often reported that the visit lasted about 1 min – 49.43% in group G versus 17.48% in group S. The five-minute visit was reported by 42.61% of group G women and 55.94% of group S patients. The patients who had subarachnoid anaesthesia almost four times more frequently reported 10-minute visits compared to group G women (22.38% and 5.68%, respectively). The pre-operative visit lasted more than 10 min for 4.20% of group S women and 2.27% for those who had general anaesthesia.
The length of pre-operative visits and satisfaction with anaesthetic care were found correlated. The longer the visit, the higher the satisfaction with anaesthetic care and anaesthetic procedures was (p <0.05). Moreover, the better informed the patients were about the method of anaesthesia, the more satisfied with anaesthetic care they felt (p <0.05).
In the present study, the attending anaesthetists were rated high by the respondents; however, some differences were observed depending on the method of anaesthesia used. In the opinions of the women who received subarachnoid anaesthesia, the anaesthetist was more trustworthy, kind, polite and competent, which is likely to be associated with longer contact with the patient during regional anaesthesia – the patient is awake during surgery and the anaesthetist spends more time taking care of her well-being. In general anaesthesia, the time of conscious contact between the anaesthetist and the parturient is markedly shorter and is limited to the pre-operative visit. The conversation is shorter as the general anaesthesia is usually performed in more urgent cases compared to regional procedures.
The ability to communicate well with the patients is a priority in medical practice; good communication is an essential element influencing the patient’s satisfaction . The patient’s involvement in decision making regarding management has a significant impact on the level of satisfaction with medical services [6, 7, 8 ]. Accurate and detailed information is also relevant for the degree of patients’ satisfaction with ambulatory nursing care . Thus, our results are consistent with the literature data.
Amongst the women receiving subarachnoid anaesthesia, the pre-operative visits were likely to be longer as their knowledge about this method was poor, thus broader explanations were needed. Longer preoperative visits and continuous contact with the anaesthetist during surgery resulted in higher trust to the attending anaesthetist compared to women who underwent general anaesthesia.
Regional anaesthesia for Caesarean section enables better contact with the parturient and may influence her knowledge and opinions about the responsibilities of anaesthetist, which appears to be important in the days of trust crisis concerning the medical profession.
The lack of trust in the anaesthetist, of varied aetiology, can result from insufficient promotion of this profession in the society . The studies carried out in Israel show that about 10% of patients do not know that anaesthetists are physicians , and only 4 % of them know anything about the anaesthetist’s responsibilities outside the operating room. The Arabian studies demonstrate that only 55.3% of patients realise that anaesthetists are medical specialists . Nowadays, the recognition of anaesthetists as separate specialists is much wider in comparison to the previous decade. In the Spanish study of 1996, about 2% patients were aware of the fact that anaesthetists are physicians with medical diplomas .
Considering deficient knowledge of patients regarding responsibilities of anaesthetists, the respondents were asked to define the most relevant characteristics of anaesthetists. In the both groups examined, professionalism, calmness, trust, accurate information, patience and politeness were found most important. The least relevant elements were the feelings of intimacy and privacy. In some other similar studies, the reported order was different: professionalism, trust, accurate information and intimacy. Interestingly, the politeness was least important .
1. Detailed and in-depth pre-operative talks about the anaesthetic procedure influence the satisfaction of patients undergoing Caesarean sections.
2. The anaesthetist’s image is ranked higher by subarachnoid than by general anaesthesia patients.
3. There is a direct relation between satisfaction of patients with anaesthesia and perception of anaesthetists.
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