Why are English anaesthetists anonymous?

In England, through the NHS, when you are to have surgery requiring a general anaesthetic, you have a ‘consultation’ with the allocated surgeon, they explain the risks and you are scheduled. For many procedures, the major ‘risk’ though is not from the surgery itself, but the anaesthetic. Surely, then, it is the anaesthetist that you need most confidence in, not the surgeon? So, why don’t they arrange for you to ‘meet’ your anaesthetist beforehand?

The role of the anaesthetist in surgeries involving general anaesthesia is crucial. While surgeons often receive the most visibility and credit, the anaesthetist plays a critical role in ensuring the patient’s safety and comfort during the operation. Their expertise in managing the risks associated with anaesthesia—ranging from breathing difficulties to cardiovascular complications—often has a greater impact on patient outcomes than the surgical procedure itself.

Why Don’t Patients Typically Meet the Anaesthetist Before Surgery?

1. Systemic Prioritisation of the Surgeon The consultation with the surgeon serves multiple purposes: obtaining informed consent for the procedure, discussing surgical risks, and addressing specific concerns about the operation itself. The system has historically prioritised this interaction because the surgeon is seen as the principal figure in the treatment plan. While this may seem logical, perhaps it is time for this to be reassessed for certain procedures?
2. Anaesthetist Workflow Anaesthetists typically review patient records in advance but only meet patients on the day of surgery. This arrangement reflects the operational structure of NHS hospitals, where anaesthetists often work across multiple cases in a day, sometimes without knowing which specific patients they will be assigned to until the day of surgery. You could say the same about garage mechanics, but there’s a reason why many people prefer to use the same small garage where the mechanic is familiar with the individual and their vehicle. It’s called trust.
3. Efficiency Considerations Scheduling pre-operative meetings with anaesthetists for every patient would add to the logistical burden on already overstretched NHS resources. While desirable, it may not be deemed cost-effective given current staffing and time constraints. Of course, and many people might not be bothered, but what about offering it just in case the patient would like to?
4. Low Incidence of Anaesthesia-Related Complications Advances in anaesthesia have made severe complications increasingly rare. With pre-operative assessments conducted via questionnaires and tests, anaesthetists can usually identify potential risks without requiring additional meetings. Which seems to run counter to the list of concerns that the surgeon describes…? Is a more balanced perspective called for?
5. Pre-Operative Assessment Clinics In NHS hospitals, anaesthetic risks are sometimes addressed during pre-operative assessment clinics. These are often staffed by nurses or junior doctors who relay information about anaesthetic risks, relying on the anaesthetist’s later review to finalise plans. However, this indirect system may leave patients feeling disconnected from the person most responsible for their immediate well-being during surgery.

Would Meeting the Anaesthetist Improve Patient Confidence?

Yes, for several reasons:

• Personalised Risk Discussion A meeting would allow patients to discuss concerns specific to anaesthesia, such as prior adverse reactions or pre-existing conditions.
• Informed Decision-Making Patients could gain a clearer understanding of how their anaesthetic plan aligns with their health needs.
• Increased Trust Building rapport with the anaesthetist would enhance trust and reduce pre-surgery anxiety.

What Could Be Done?

1. Structured Anaesthetist Consultations for High-Risk Patients Introducing pre-operative meetings for patients identified as high-risk for anaesthesia could balance resource constraints with patient safety.
2. Video or Written Briefings Pre-recorded briefings by anaesthetists could explain common risks, leaving in-person consultations for more complex cases.
3. Pre-Operative Clinics with Anaesthetist Input Expanding the role of anaesthetists in these clinics could ensure more direct patient interaction without disrupting operating schedules.

While systemic limitations are a factor, giving patients access to their anaesthetist beforehand would likely improve confidence and satisfaction with care. It might also help shift perceptions about the collaborative nature of surgical teams.