Indian Journal of Anaesthesia  
About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions
Home | Login  | Users Online: 43  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size    




 
CLINICAL INVESTIGATION
Year : 2007  |  Volume : 51  |  Issue : 5  |  Page : 420 Table of Contents     

Public Awareness About Anaesthesia and Anaesthesiologist: A Survey


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 Acceptance10-Sep-2007
Date of Web Publication20-Mar-2010

Correspondence Address:
Udita Naithani
II-238, OTC Scheme, Charak Marg, Udaipur, Raj
India
Login to access the Email id


Get Permissions

 

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

How to cite this URL:
Naithani U, Purohit D, Bajaj P. Public Awareness About Anaesthesia and Anaesthesiologist: A Survey. Indian J Anaesth [serial online] 2007 [cited 2014 Sep 2];51:420. Available from: http://www.ijaweb.org/text.asp?2007/51/5/420/61174


   Introduction Top


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 [1] . 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" [2] . 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 Top


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 Top


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 Top


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 [3],[4] . This was in contrast to the findings of the study conducted by Swinhoe et al [5] 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 [6],[7] . 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 [5],[8] .

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 [5],[7],[8],[9] . 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 [7] .

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 [7] . 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 [6],[10],[11] the major preperative con­cern was awareness during anaesthesia and failure to gain consciousness followed by intra and postoperative pain. In Asian studies [3],[7] 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 [12] . 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 [4] .

There is a desire amongst the patients to know about anaesthesia and anaesthesiologist as found out by stud­ies all over the world [3],[4],[7] 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 [4] (P<0.001). This was in contrast to the findings of Gurunathan et.al [7] . 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 [7],[13] (P>0.1). This was in contrast to Baaj et al [4] where past exposure contributed to increased knowledge about anaesthesia.


   Conclusion Top


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.

Annexure "1"

Preoperative questions

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
  • Anaesthesiologist
  • 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

  • Pain
  • Fear being aware of getting operated.
  • Death during surgery
  • Needle prick
  • Others


II. Fears After Surgery

  • Pain
  • Nausea, Vomiting
  • Won't regain consciousness
  • Others


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?

  • General Anaesthesia
  • Regional Anaesthesia
  • Both
Q.14 What discomfort did you have?

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

 
   References Top

1.Armitage EN. The public image of the speciality (letter). Ana­esthesia 1978; 33:64-5.  Back to cited text no. 1      
2.Vandam LD. AmericanSociety of Anesthesiologists Rovenstine lecture-1979; anesthesiologists as clinicians. Anesthesiology 1980; 53:40-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Chew ST, Tan T, Tan SS, Ip-Yam PC. A survey of patient's knowledge of anaesthesia and perioperative care. Singapore Med J 1998; 39: 399-402.  Back to cited text no. 3  [PUBMED]    
4.Jumana Baaj, Mohammad Said, Maani Takrouri, Badeah M. Hussein, Hassan al Ayyaf. How much surgical patients at the King Khalid University Hospital (KKUH) know about their anesthesia and anesthesiologists. The Internet Journal of Health 2005. 4:2 www.ispub.com.  Back to cited text no. 4      
5.Swinhoe CF, Groves ER. Patient's knowledge of anaesthetic practice and the role of anaesthetists. Anaesthesia 1994; 49: 165-66.  Back to cited text no. 5  [PUBMED]    
6.Shevde K, Panagopoulos G. A survey of 800 patient's knowl­edge, attitudes and concerns regarding anesthesia.AnesthAnalg 1991; 73: 190-8.  Back to cited text no. 6      
7.Usha Gurunathan, Rebecca Jacob. The public's perception of anaesthesiologists - Indian attitudes. Indian J Anaesth 2004; 48: 456-460.  Back to cited text no. 7      
8.Herman CR. An appraisal of anaesthetist - patient relation­ship. Anaesthesia 1978; 33: 45-48.  Back to cited text no. 8  [PUBMED]    
9.Keep PJ, Jenkins JR. As others see us. The patient's view of the anaesthetist. Anaesthesia 1978; 33: 43-45.  Back to cited text no. 9  [PUBMED]    
10.Hume MA, Kennedy B, Asbury AJ. Patient knowledge of ana­esthesia and peri-operative care. Anaesthesia 1994; 49: 715-718.  Back to cited text no. 10  [PUBMED]    
11.Matthey P, Finucane BT, Finegan BA. The attitude of the gen­eral public towards preoperative assessment and risks associ­ated with general anaesthesia. Can J Anaesth 2001; 48: 333-39.  Back to cited text no. 11  [PUBMED]    
12.VanWijkMGF,Smalhout B.Apostoperativeanalysisof thepatient's view of anaesthesia ina Netherlands' teaching hospital. Anaesthesia 1990; 45: 679-682.  Back to cited text no. 12      
13.Kindler CH, Harms C, Alber C. The patients' perception of the anaesthetist in a Swiss University Hospital. Anaesthesist 2002; 51: 890-6.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Methods
    Results
    Discussion
    Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1535    
    Printed94    
    Emailed1    
    PDF Downloaded217    
    Comments [Add]    

Recommend this journal