|Year : 2007 | Volume
| Issue : 5 | Page : 420
Public Awareness About Anaesthesia and Anaesthesiologist: A Survey
Udita Naithani1, Dharam Purohit2, Pramila Bajaj3
1 M.D., Assistant Professor, Deptt. of Anaesthesiology, R.N.T. Medical College, Udaipur(Raj.), India
2 M.D., Ex-P.G. Student, Department of Anaesthesiology, R.N.T. Medical College, Udaipur (Raj.), India
3 M.D., F.I.C.S., F.A.M.S., Sr. Professor and Head, Department of Anaesthesiology, R.N.T. Medical College, Udaipur (Raj.), India
|Date of Acceptance||10-Sep-2007|
|Date of Web Publication||20-Mar-2010|
II-238, OTC Scheme, Charak Marg, Udaipur, Raj
Source of Support: None, Conflict of Interest: None
Though the role of anaesthesiologist is crucial, the public knowledge of anaesthetic practice is limited. It is thus important for us to think that why the importance of this speciality is not known and how to make people aware about the vital role played by an anaesthesiologist in medical set up. The present study was conducted in a tertiary care teaching hospital, on 150 adult surgical patients posted for elective surgery to assess patient's knowledge about the role of anaesthesiologist, their preoperative concerns related to anaesthesia, post operative complaints and level of satisfaction regarding anaesthesia services. A majority (92.67%) of patients felt that anaesthesia was necessary for surgery, only 42.67% knew that it was given by an anaesthesiologist. Only 27.33% of the patients knew that besides anaesthetizing, anaesthesiologists monitors & takes care of vital signs throughout surgery. Patients were not much aware of their role in ICU (7.33%), painless labour (12.67%) & pain clinic (4.67%). Only 15.33% patients had knowledge about anaesthesia risks given in consent form. Though people with higher literacy levels had greater knowledge about anaesthesia compared with the lower literacy group (P<0.001), even their mean scores fell in average range. The statistical association between past exposure to anaesthesia and knowledge about anaesthesia was not significant (P>0.1). Contribution of anaesthesiologists in patients knowledge was the least (1.33%). The number of patients having preoperative fears was much more (61.33%) than the actual number of patients having discomfort during surgery(16.67%). Large majority of patients were satisfied with the quality of anaesthesia services (99.33%), and showed willingness to know about their anaesthesiologist in case of any future surgery (70%). We concluded that there is a widespread misconception amongst the public about the role of anaesthesiologists inside and outside the operating room, however services provided were considered satisfactory. Therefore, sufficient time should be given to educate the patients about anaesthesia and the various role an anaesthesiologist plays. Meeting during the preanaesthetic examination should be used to fulfill this purpose.
Keywords: Anaesthesia, Awareness, Patients, Attitude
|How to cite this article:|
Naithani U, Purohit D, Bajaj P. Public Awareness About Anaesthesia and Anaesthesiologist: A Survey. Indian J Anaesth 2007;51:420
| Introduction|| |
Withtime, anaesthesiology as a speciality has evolved leaps & bounds. The problems of image and status of anaesthesiologists in eyes of the medical and lay communities are not new  . In the Rovenstine Memorial Lecture in 1979, Leroy Vandam spoke of the history of this problem and offered his views on ways in which individuals can elevate the level of their practice to that of "anaesthesiologist-clinicians"  . Many, if not all, practicing anaesthesiologists have struggled at some point with issues relating to the status and image of the speciality. It has been felt that though the role of anaesthesiologist is crucial, he doesn't get the due he deserves. As the health care environment changes and the speciality of anaesthesiology evolves, the need and challenges for educating the individual patient and the public at large have never been greater. It should be known that how much the patients who are going to get anaesthesia know about the role of anaesthesiologist and anaesthesiology. The results should be analyzed and ways to improve their knowledge should be sought.
The present study was conducted to assess patient's knowledge about the role of anaesthesiologists, their fears and apprehensions before surgery, their postoperative complaints and level of satisfaction regarding quality of anaesthesia services.
| Methods|| |
This cross sectional study was conducted at a tertiary care teaching hospital on 150 adult patients posted for elective surgery under all specialities, except CVTS and neurosurgery, over a period of 6 months. Prior permission from ethical committee and a written informed consent from all patients was taken.
A questionnaire comprising 16 questions (Annexure 1) prepared in both Hindi and English was given to the patients with each question verbally explained as a number of patients in our study were illiterate.
The study was conducted in two parts. In the first part questions were asked preoperatively. Nine questions were asked to judge patient's knowledge about anaesthesia and anaesthesiologist. Scoring was done on these nine questions and each correct response was given one and incorrect response was given zero mark. Patients giving don't know as their response were also awarded zero mark. Maximum score was nine while minimum score was zero. Score for each individual was found out. The interpretation of score was <3 - poor, 36 - average, >6 - good knowledge about anaesthesia. The other questions asked preoperatively were to know about the source of information given by the patients and to know about patients fears and apprehensions before surgery.
The second part of the study was conducted postoperatively. Patients were asked questions six hours after surgery. The purpose of these questions was to know about the complaints of the patient during and after surgery, level of satisfaction regarding quality of anaesthesia services and willingness to know about anaesthesiologist in case of future surgery.
Patients were asked to rate their satisfaction regarding the quality of anaesthesia services. The illiterate and rural people were asked to express it as a fraction of rupee while the literate people expressed it as percentage which was interpreted very poor, poor, fair, good and very good.
Statistical analysis was done to find out the relationship of patient's literacy level and past exposure to anaesthesia with knowledge about anaesthesia. One way Anova (Analysis of variance) for randomized group was used to find the correlation between patient's knowledge about anaesthesia & increasing literacy levels. Student 't' test was used to find the correlation between patient's knowledge about anaesthesia and past exposure to anaesthesia.
| Results|| |
Of the 150 patients, 87 were males while 63 were females. Patients were divided on the basis of literacy levels. 30% were illiterate, 18% had primary, while 24% had secondary education, 20% had education of class XI-graduate level, while 8% were postgraduates. 30% of the patients were scheduled to undergo general surgical, 25% orthopaedic, 22% gynae & obstetrical and 23% ENT procedures. 54% of the patients had been operated before.
A majority (92.67%) of the patients felt that anaesthesia was necessary for surgery while 7.33% of the patients did not know the answer. None of the patients said that surgery can be performed without anaesthesia.
42.67% of the patients knew that anaesthesia was given by anaesthesiologist [Figure 1].
Regarding the role of anaesthesiologist in operation theatre, only 27.33% of the patients knew that besides anaesthetizing, anaesthesiologists monitor their vital signs throughout surgery [Figure 2]. Patients aware of anaesthesiologist's role in ICU, painless labour and relief of chronic pain were only 7.33%, 12.67% and 4.67% respectively.
On being asked whether the presence of concomitant disease (diabetes, hypertension, asthma, epilepsy, liver disease);being an alcoholic or a smoker or of geriatric age group increase the risks during anaesthesia, 52% felt that the risk during anaesthesia increased. Only 34.67% of the patients were aware of the information given in the consent form which they or their relative had signed. Only 15.33% of the patients had knowledge about anaesthesia risks given in consent form.
Scoring was done on the data obtained from 9 questions. Score of patient depicted his knowledge about anaesthesia. A majority of patients (62%) had poor knowledge about anaesthesia while a very few (6%) had good knowledge about anaesthesia [Figure 3].
Mean scores obtained by each group were used for statistical analysis [Table 1].
Comparison of mean score of patients divided on the basis of literacy levels is shown in [Figure 4]. The graph in figure shows increasing mean scores with increasing literacy level, but even the highest mean score was in the average range (i.e. had average knowledge about anaesthesia). None of the literacy groups had a mean score >6 (good knowledge about anaesthesia) Correlation between patient's knowledge about anaesthesia & increasing literacy levels was statistically highly significant (P<0.001).
The correlation between patient's knowledge about anaesthesia and past exposure to anaesthesia was found to be statistically non significant (P>0.1) [Table 2].
On being asked about their source of above information given, 64% of the patients replied that they 'knew it before hand'. 16% of the patients came to know about it from their friends and relatives while TV/ Newspapers were the source of information for 10.67% of the patients. The surgeon and anaesthesiologist were the source of patient's information in 8% and 1.33% of cases respectively.
When asked about preoperative fears and postoperative complaints some patients gave multiple answers, so their sum may be more than or may not add upto 100%. 62% of the patients had preoperative fears before surgery. The main preoperative fears of the patients were pain during surgery (36%), awareness during operation (22%), death during surgery (16.67%) as distinct from failure to regain consciousness (10%), needle prick (14%) & postoperative pain (11.33%). Other concerns were about adverse effect of anaesthetic drugs, postoperative nausea and vomiting, paralysis, not being cured by surgery etc.
General & regional anaesthesia was given to 56% & 44% patients respectively. A postoperative analysis was done 6 hours after surgery. Patients were asked about discomforts during and after surgery. 83% of the patients had no discomfort during surgery. The discomforts during surgery were pain (9%), cold & shivering (5%), nausea and vomiting (3%), aware of being operated under general anaesthesia (2%) etc. 72% of the patients had discomfort after surgery. The major postoperative discomforts were pain at the site of surgery (50%) and nausea & vomiting (24%).
Patients rating the services as fair (7.33%), good (22%) and very good (70%) were considered satisfied with the services. Thus an overwhelming number of patients (99.33%) were satisfied with the quality of anaesthesia services. Only 0.67% of patient's considered the services poor.
When asked about future inclination to know about anaesthesiologist a majority of patients (70%) were interested in getting more information about anaesthesia and anaesthesiologist.
| Discussion|| |
In our study, though anaesthesia was considered necessary for surgery by a majority of patients, a large proportion (58%) of them did not know about the person who anaesthetises them , . This was in contrast to the findings of the study conducted by Swinhoe et al  in UK where 80% of the patients knew that an anaesthesiologist would give them anaesthesia. This could be because of the fact that UK is a developed country with a high literacy percentage and also because of greater interaction between the anaesthesiologist and the patient during the preanaesthetic examination.
We found that the role of an anaesthesiologist after induction of anaesthesia was not clear to many patients , . This was in contrast to the findings of surveys conducted in developed countries where a majority of patients felt that anaesthesiologist stayed during operation to look after their breathing, blood pressure & intravenous fluids , .
The role of an anaesthesiologist outside the OT - ICU, painless labour & pain clinic was not known to a majority of patients as substantiated by our and other studies ,,, . Most of the patients in present study having knowledge about the role of an anaesthesiologist in painless labour, got this information from an article on painless labour in a popular local daily. This suggests that media can play an important role in educating people about our role.
Nearly half of the patients felt that if the patient suffers from any other disease (like diabetes, hypertension, asthma, epilepsy, liver dysfunction), is old, is a smoker or an alcoholic, then risks during anaesthesia increase  .
Our study tried to find out the number of patients who were aware of the information given in the consent form which they or their relatives had signed for approval of surgery. It was disappointing to know that only 34.67% of the patients were aware of the information given in the consent form. Even more disappointing was the fact that only 15.33% of the patients had knowledge about anaesthesia risks given in the consent form. Possible reasons for this could be the God like image of a doctor in our country where the patient completely relies and trusts the surgeon's decision. He hands himself to the surgeon and considers signing the consent form a formality. Illiteracy could also be the reason; busy hospital schedule not giving doctors enough time to explain the risk factors could be another reason. A few patients complained that they couldn't read the printed matter on the consent form, as it was hazy.
It is important to know about the source of information given by the patient. It helps us to know the cause of patient's beliefs, information, misinformation and ignorance regarding anaesthesia and anaesthesiologists. When asked about the source of their information, most of the patients replied that they knew it before hand. It could be because of patients own experience or other factors, which the patient couldn't recall. Friends, media and their doctor contributed to the knowledge of remaining patients  . But the most important finding was that the contribution of an anaesthesiologist in providing information was the least (1.33%). This could be because an anaesthesiologist usually gets limited time during the pre-anaesthetic examination to provide information regarding the speciality and explain the advantage & disadvantage of the procedure. On some occasions the anaesthesiologist meets the patient for the first time in operation theatre since the person doing preanaesthetic examination and the one providing anaesthesia are different.
In Western studies ,, the major preperative concern was awareness during anaesthesia and failure to gain consciousness followed by intra and postoperative pain. In Asian studies , including ours the major preoperative concern was pain (intra and postoperative) followed by failure to wake up after surgery and aware of being operated.
We found that the actual discomforts of the patient during surgery were less and different from the preoperative fears. Since most of the patient fears regarding operation were unfounded, there is a need of proper education and communication to allay unrealistic fears and anxiety. The patient will then know what to expect and will cooperate with us in performing our task. None of the patients in our study suffered mortality.
In our study 72% of the patients had discomfort after surgery. The complaint of postoperative pain was much more than the Netherlands study  . This could be because of the fact that anaesthesiologist has little role in postoperative analgesia in our institute. Meticulous intubations, attention to the position of the patient on the operating table & improvement of its surface, adequate covers (rewarming mattress), a high operating room temperature, more extensive use of antiemetic drugs, greater attention to postoperative analgesia can abolish some of these grievances.
Whatever be the patient's level of education or knowledge of anaesthesia practice, the patients were in majority happy and highly satisfied with anaesthesia services  .
There is a desire amongst the patients to know about anaesthesia and anaesthesiologist as found out by studies all over the world ,, including ours, so efforts should be taken to educate them.
In our study, the correlation between patient's knowledge about anaesthesia and increasing literacy levels was statistically significant  (P<0.001). This was in contrast to the findings of Gurunathan et.al  . Though knowledge increased with increasing literacy levels, the highest literacy level too fell in the category of average knowledge about anaesthesia.
The correlation between patient's knowledge about anaesthesia and past exposure to anaesthesia was found to be statistically non significant , (P>0.1). This was in contrast to Baaj et al  where past exposure contributed to increased knowledge about anaesthesia.
| Conclusion|| |
The available data suggest that speciality of anaesthesia has not done all that it can to educate the patients in particular and the public at large about the role of an anaesthesiologist. This can be explained by the fact that an anaesthesiologist gets to 'talk' with his patient only during patient's preanaesthetic examination (PAE). Sufficient time should be given during PAE to educate the patient about anaesthesia and the role of anaesthesiologist.
Anaesthesiologist should take consent from the patient after verbally explaining all the advantage & disadvantages of the procedure. The task of taking consent should not be left to the surgeon alone. A familiar friendly face in an unfamiliar environment (operating room) goes a long way to allay anxiety.
The educational efforts made during preoperative and postoperative visits may be supplemented through broader avenues such as news items in newspapers, magazines, radio and television. Education of other health care professionals who already have considerable credibility with patients may be enhanced by publishing papers in their journals and by participating in multidisciplinary hospital committees since the ability of the speciality to develop also depends upon its success in educating the public, politicians, and other health care professionals about its role.
Q.1 Have you or your close relative ever been operated before?
Yes / No.
Q.2 Do you think Anaesthesia is necessary for surgery?
Yes / No / Don't know
Q.3 Who will anaesthetize you?
- Operating surgeon
- Nurse/ Compounder or other
- Don't know
Q.4 What do you think is the role of an anaesthesiologist in operation theatre?
- Only anaesthetizes but stays in the operation theatre.
- Other than anaesthetizing the patient takes care of patient's respiration, heart, blood pressure, pulse and other vital parameters.
- Leaves the operation theatre after anaesthetizing the patients.
- Don't know.
Q.5 Is there any role of an anaesthesiologist in reviving a patient when his heart stops working (CPR) or on taking a patient on ventilator (a machine that provides artificial respiration) in case of serious respiratory insufficiency or in an Intensive Care Unit (I.C.U.)?
Yes / No / Don't know
Q.6 Is there any role of an anaesthesiologist in performing painless labor?
Yes / No / Don't know
Q.7 Is there any role of an anaesthesiologist in relieving long standing pains related to cancer, back, sciatica etc.? Yes / No / Don't know
Q.8 Are you concerned or afraid about anything before surgery?
No / Yes
I. Fears During Surgery
- Fear being aware of getting operated.
- Death during surgery
- Needle prick
II. Fears After Surgery
- Nausea, Vomiting
- Won't regain consciousness
Q.9 If the patient suffers from any other disease (like Diabetes, Hypertension, Asthma, Epilepsy, Liver dysfunction), is old, is smoker or an alcoholic then risks during anaesthesia increase?
Yes / No / Don't know
Q.10 Where did you get the above information from?
- Knew it before hand.
- Was told by the surgeon.
- Was informed by friend or relative.
- Came to know from TV or news paper.
Q.11 Are you aware of the information given in the consent form which you or your relative have signed for approval of surgery?
Yes / No / Don't know
Q.12 If yes, then is there any information given regarding risk of Anaesthesia?
Yes / No
Post operative questions
Q.13 What was the method of Anaesthesia?
Q.14 What discomfort did you have?
- General Anaesthesia
- Regional Anaesthesia
I. During Surgery
Pain, anaesthesia, headache, difficulty in breathing, cold, shivering, nausea, vomiting, any other problem, faced no discomfort
II. After Surgery
Pain - where, when (time after surgery), headache, difficulty in breathing, cold, shivering, nausea, vomiting, pain, burning in throat, difficulty in speaking, awareness of having tube in throat, felt hungry and thirsty, regained consciousness after long time, any other problem, faced no discomfort.
Q. 15 What was the level of your satisfaction regarding anaesthesia?
Not at all, 25%, 50%, 75% Complete satisfaction 100%
Q.16 In case of any future surgery would you like to know about your anaesthetist?
Yes / No
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]