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The Partnership between Surgeons and Anesthesiologists
Evangelia Michail Michailidou1,2,3,4*
1Intensive Medicine Department, Hippokration General Hospital, Greece
2Senior Student in the Department of Business Administration, University of Macedonia, Greece 3Masters Degrees, International Medicine-Health Crisis Management, Greece
4Member of Health Response team to Crisis Situations of G.H.T.Hippokration, Greece
Received Date: 18/09/2020; Published Date: 23/09/2020
*Corresponding author: Evangelia Michailidou, Consultant Anesthesiologist-Intensivist, General Hospital Hippokratio of Thessaloniki, Konstantinoupoleos 46, Thessaloniki, Greece
Abstract
Teamwork is now recognized as essential to healthy, high-quality perioperative treatment. The partnership in-surgeon – anesthesiologist dyad is perhaps the most important aspect of the overall team success. Well-functioning collaborations are conducive to secure, successful treatment. An unhealthy relationship can foster unhealthy conditions and lead to a negative outcome. And there is no study on this interaction, about what fits well or not well, and what can be done to improve it. This essay discusses the practical and unhealthy facets of the relationship, describes certain common perceptions of each occupation and calls for study to further identify and appreciate how to strengthen working relationships.
Teamwork is one of the most important factors of perioperative patient care for the members of the operating room team. However, the largest uncertainty of the impact of team success on results and protection can be correlated with one dyad in the unit: the relationship between the surgeon and the anesthesiologist. If it is accurate that leadership dyads are a crucial factor in the protection, consistency and/or efficacy of the operating room staff, then the dyad of the surgeon and anesthesiologist is the dyad we should strive to learn and maximize. The triad partnership between the surgeon and the anesthesiologist and others is also crucial to maintaining safety, efficiency and consistency. The relationship between the two physicians who often share, give or fight for leadership has the ability to allow or hinder performance that may exceed that of the other dyads or multiple, parallel interactions.
What do we know about the Relationship between a Surgeon and Anesthesiologist?
In this sense, "relationship" is about how well two people get along, how well they support and trust each other and their views, how much they depend on each other for input, how willing they are to keep each other aware of the acts that involve their dyadic partner. There is evidence that refers to certain scientific facets of the interaction between a physician and anesthesiologist. Coordination and dispute have been studied and recommendations have been made to resolve them. Conflict in the operating room between individuals — mostly between anesthesiologists and surgeons — is a big problem and has been encountered or observed by virtually everyone involved in the operating room. Although conflict linked to clinical choices is normal and safe if properly handled, personal disagreement is not safe and is seldom in the best interests of the patient [1-3].
Conflicts can occur due to the vagaries of work and human beings, particularly though there is a relatively healthy relationship between the parties. It may also be a noticeable and potentially harmful representation of a suboptimal or toxic relationship. Whether the disagreement is troublesome depends on how it occurs and how the individual handles it. Too much, this isn't done properly. The length of a surgeon – anesthesiologist partnership is variable - sometimes people have only just met; others have worked together for a long time.
Familiarity often offers mutual trust that tends to defuse conflict; at other times, it creates an ingrained unhealthy partnership and mistrust. A variety of facets of conversation, function expectations, various mental styles, and the tone required activating speech, and related issues have been discussed in multiple research. There is no focus on any of these papers on understanding the origins or how to enhance the reliability and instability of the surgeon – anesthesiologist dyad. Unfortunately, little is written about successful relationships in health care, particularly examples of good working relationships that are more likely to be more prevalent in some environments than in others. There is justification to conclude that they make a substantial contribution to productivity, protection and performance.
Personal Remarks & Observations
Over my experience of patient safety and efficiency, I have been drawn to this subject by personal insights and interactions with anesthesiologists and surgeons. The word "tribe" should be used to identify the various occupations in the operating room, e.g. physician, nurse, anesthesiologist, surgical assistant, for insight into how tribal instincts and actions can be detrimental between tribes and culture [4-7].
a. Observation 1: While the dyad is fully efficient, it is of immense benefit to the patient; one will support and "rescue" the other. And a healthy working relationship (for all) provides a far more friendly working atmosphere.
b. Observation 2: While the dyad is broken, it can — and does — often contribute to damage and sometimes produces an uncomfortable and often dangerous working atmosphere.
c. Observation 3: Each side of the dyad has some impressions of the other side which are damaging. If I had to ask each other what they think of the other profession in general, the first reaction would contain certain comments that are complementary. (Corollary: both will share similar perceptions with other medical tribes when working together)
d. Observation 4: At times, each side of the dyad applies motives to the other that are not purely in the best interests of patients.
Poor Impressions of Surgeons for Anesthesiologists
Such negative views of anesthesiologists include: lack of understanding of "anesthesia-related" (as opposed to surgical) issues; lack of comprehension or appreciation of the degree of blood loss; persistent underestimation of surgical time; Failing to warn patients and caregivers about the chances of success and the extent of the difficulties of rehabilitation following surgery; failing to give proper attention to patient health needs and patient desires; and avoiding people to chat about safety issues.
Poor Views of Anesthesiologists by Surgeons
Several of the negative views of anesthesiologists by surgeons include: more concern with completing their day on time than meeting the needs of their patients; unreasonably eagerness to postpone a operation based on unjustified concerns; lack of respect for the need to follow a schedule; undue turnover times; Distraction and inattention during surgery; inability to explain major improvements in vital signs to the whole team; failure to keep the team aware of the need for vasopressor support; lack of awareness of the interaction between the patient and the surgeon; and reluctance to adjust the anesthetic strategy of the need for the surgeon of maximize surgical technological requirements.
Related Principles
Surgeons and anesthesiologists have different roles that can lead to varying beliefs and reasons for what they think best for the patient. The group in which everyone was educated has established a collection of principles and ideals that are consistent with what has traditionally sustained its performance over the years. Haidt examines extensively how beliefs are formed in our cultures and how they influence our view of the "other." As all tribes, the collective performance of the group can contribute to negative views of other groups. As a consequence, some discord between two people from separate tribes is expected. Hope for enhancing the dyad efficiency for the good of the patient derives from the awareness and appreciation of discrepancies and attempts to overcome or satisfy them.
What does a Perfect Relationship Look Like?
As patient, someone, expects his surgeon and anesthesiologist to operate in full peace, setting aside their personal concerns for my wellbeing and well-being. Surgeons and anesthesiologists should develop a better understanding of the expectations and limitations of each other's professional interests of patients in general as well as for any particular patient. This will have risen long enough in advance to value the time taken to resolve these questions. (Ideally a day or so in advance, or even a significant "huddle" before getting the patient to the operating room. Immediate pre-surgery time might be necessary for certain prosaic needs.) Should be open to and willing to hear the views and viewpoints of the other, even though they appear to conflict with their own field of expertise. It will only work by inspiring to ask questions. Each of them will often begin with an extension of the "simple presumption" (from simulation-based debriefing) to the other: "I assume you are educated, knowledgeable, working your utmost to do your best and striving to change, and behaving in the best interests of this patient and the institution." Where there is a genuine dispute as to what choice to take, the discussion will rely on what is best for the case, not who is best. Examples of missed factors that may lead to an optimum partnership include interdisciplinary morbidity and mortality or case analysis and an efficient huddle.
Over the years, we have studied and survey unidisciplinary and interdisciplinary quality improvement boards in hospitals. They do have benefits and drawbacks. Overall, it appears to be extremely beneficial to discuss / debrief difficult cases or adverse effects as a team. There are obstacles to doing this, such as various job schedules, or the need to be secure outside one's own community to say something that may be important. Thankfully, those interprofessional debriefings appear to be growing such that we can assume that this will have a positive effect on the overall work.
What kind of Analysis will lead to Deeper Understanding?
Investigations into ties between members of the perioperative team did not answer any of the concerns I asked at the outset. Surveys, focus group discussions, observational experiments, crucial event or comprehensive ethnography may all be used to shed light on the problems that render the surgeon-anesthesiologist dyad highly efficient or totally dysfunctional. Case studies of examples of both stable and unhealthy relationships, and in particular more complex facets of partnerships that can relate to under-optimal treatment, will help increase awareness about how habits and actions can lead to the best about treatment or the worst of care and everything in between. Replicating that with a focus on the relationship between a surgeon and anesthesiologist, both parties might shed light on the issues.
Another field of research and understanding that can be beneficial is that of emotional intelligence. Emotional intelligence is increasingly seen as essential for good relationship management.
Discussion
- What can be done in the meantime, until we have further proof?
If you are an anesthesiologist or surgeon and think that what I am recommending is worth pursuing in order to enhance the perception of your patients and your pleasure and sense in your clinical practice, what can you do in the absence of scientific evidence?
- Some ways to resolve the issue
- Asking a colleague of the other tribe regarding his or her impressions of the members of your tribe.
- Have a conversation about the origins of these experiences.
- It's usually better to do this on a relaxed meal or cocktail rather than on an "other phone" scenario.
- Organize a concentration or dialogue group, with a few members of each tribe.
- The effectiveness of such activities will be improved by a competent facilitator.
- One subject for a focus group may be the specific recognition how leadership can be communicated or identified in various contexts.
Any time a circumstance happens that makes you realize like a relative from the other team is doing something that appears to be more in their own best interest than in the patient's interest, interested and metacognitive. Think what other theories there may have been. If you can do it in a non-threatening, non-accusatory manner, you can ask the person; however, it is not easy to be able to pull it off with genuine sensitivity and complexity. This is an ability that needs preparation and practice. If you are good enough to work in a hospital that has a simulation curriculum and a full operations team experience, make advantage of it or build a chance to join.
If the concerns mentioned here appeal with sufficient intensity to a large number of surgeons and anesthesiologists, there is definitely a role that the national association of Surgeons and the National Society of Anesthesiologists will play in addressing the issues and moving towards a more desirable state of affairs. In view of the geographical constraints, I have not addressed all facets of this subject that are important to the comprehension and enhancement of the surgeon – anesthesiologist dyad results, e.g. operating in set versus shifting teams; relationships with other team members; output pressure; job conditions (independent or staff); Academic versus private practice. This may be part of a wider discussion and discovery phase.
You may be a surgeon or anesthesiologist for whom none of this is important and who is lucky to have a close friendship with a surgeon-anesthesiologist. However, we have ample reasons to conclude that the shoe works for everyone, and that even the best people and best partners have a tough time. Certainly, most of us know of many cases where issues in a surgeon-anesthesiologist relationship have become dangerous to patients. At the end of the day, no matter our own relationship concerns, we will all accept that keeping patients safe should be a matter of utmost concern.
References
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- Kumar M, Dash HH, Chawla R (2013) Communication skills of Anaesthesiologists: An Indian perspective. J Anaesthesiol Clin Pharmacol 29: 374-378.
- Cooper JB, Caplan RA, Gaba DM (2013) APSF Workshop Engages Audience in Communication Skills and Drills. 2013 APSF newsletter.
- Critical Role of the Surgeon-Anesthesiologist Relationship for Patient Safety.
- Cooper JB (2018) J Am Coll Surg
- Rudolph J (2019) What’s up with the basic assumption.
- Rudolph J (2019) Helping without harming. SMACC, Berlin.
- Katz D, Blasius K, Isaak R (2019) Exposure to incivility hinders clinical performance in a si Leadership, -Thomas Cooley Professor of Ethical. "NYU Stern – Jonathan Haidt – Thomas Cooley Professor of Ethical Leadership". mulated operative crisis. BMJ Qual Saf 28: 750-757.
