Retention of anaesthetists – a personal reflection from the patient perspective

Abstract

As a patient representative on the project team, I participated in the research published in the study by Gale et al. [1]. I was prompted to offer this commentary, having reflected on the research findings in light of my own experience of anaesthesia. An additional motivator was the absence of a significant amount of patient input in the literature on the impacts of stress on resident anaesthetists.

History teaches us the magnitude of what is made possible by anaesthesia in terms of lives saved and quality of life achieved. Anyone who has undergone an operation will be grateful for the painless surgery and post-surgical analgesia. I have had a general anaesthetic six times and complex post-surgical pain management once.

I had a bad reaction to the first general anaesthetic (in 1987, for dental extractions) which led me to try and avoid them in future; unsuccessfully though, in view of the nature and seriousness of the surgery to be performed. I learned subsequently that the technology of anaesthesia has improved enormously since the 1980s, which made the most recent general anaesthetic in 2020 (for lengthy abdominal surgery) much better, both in anticipation and the experience itself. Some of my apprehension over the years was probably misplaced, but anaesthesia has always been, for me, the most fearful part of surgery. The sense of my life being suspended and in the hands of one person while others are doing serious things to my body was always very real.

A patient's relationship with an anaesthetist is very circumscribed and, for the most part, ‘virtual’ through being unconscious. This places a premium on trust and confidence to put oneself completely in the care of another at a time replete with vulnerability and anxiety. On the one occasion that I can recall well, for the 2020 abdominal surgery, I was very grateful for the time that the anaesthetist spent with me before the operation, explaining procedures and offering reassurance. Equally, the surgeon spoke very confidently that we were “both in good hands”.

I have always tried to have a good functional relationship with doctors treating me, seeking a power balance that would enable me to speak openly, ask and answer questions fully. That objective thrives with cordiality and time but suffers when there is a sense of stress and being rushed. With all this in mind, reading about the pressures that resident anaesthetists are under in their training and practice would not have lessened my apprehension. It is concerning to know that they are often physically and mentally tired, sometimes without adequate rest facilities, worry about making ends meet and struggle to plan their private lives or manage family commitments. Particularly disturbing are avoidable issues that may seem individually trivial but form a cumulative burden of ‘micro-stressors’. It appears that the ‘heavy lifting’ to absorb pressure, some of it clearly preventable, is mostly done by doctors rather than organisations. This is likely to impact negatively on wellbeing and morale.

Developing resilience and preparedness for the unexpected, as well as managing a weighty list of routine tasks, are all part of training. Hence, stoicism has its place but is a negative force if it allows fatigue to accumulate and eventually develop into burnout. Being ‘tested to destruction’ cannot be healthy for the doctor, patient, team or profession.

None of this has ever been apparent in an interaction between me and a doctor to the extent portrayed by project participants. However, I have always been conscious that there is pressure of time, e.g. for a doctor to read my notes before I meet them or for me to raise all of the questions that I want to. I had assumed that this was simply a workload and resources issue but now realise that doctors are often internalising daily pressures of a wider nature and concealing them from patients. If, in the process of prioritising patient care, doctors suppress their own emotional responses to stress, they will eventually exceed their absorptive capacity and be unable to deliver care in line with their values.

While I wouldn't necessarily want to know too much detail about the pressures on my own doctors, I'm glad to be aware of and can draw attention to them in a general way now. As a patient, I want the doctors treating me to have the requisite knowledge and skills, to be rested, concentrating on the tasks before them and able to devote all their energy to looking after me. I do not want them to be impacted by anxieties around issues extraneous to the care they are giving.

It is understood that doctors need to have comprehensive, programmed training, providing a range of experiences in a range of contexts. However, I would expect that to be well-managed and not bring its own burden of stresses. Doctors should also be confident that their activities, as they build their expertise, are meaningful to that aim and not just filling a service gap. It is desirable that those involved in the training of doctors be aware of the pressures and develop balanced training programmes that impart a comprehensive set of knowledge, skills and experience, adapted to and benefiting from the diversity within the workforce.

Above all, I would want doctors to feel heard and appreciated and, ultimately, happy in their professional choices as they undertake the onerous task of supporting patients through surgery and managing their pain.