Listening and Anesthesia Quality

By October 26, 2018Uncategorized

In recent years, the Association of American Medical Colleges has prioritized empathy as a critical skill for physicians to employ in their practice, detailing that by the end of medical school, students will “value the importance of curiosity, empathy, and respect in patient care”.[1] Inherent in empathy is the art of listening, that is, that physicians have the ability to hear their patients’ concerns, empathize with the emotions behind the concerns, and respond appropriately with reference to the patient’s state at that moment in their care journey. Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) are particularly well aligned with initiatives in listening and empathy. Patients may harbor anxiety about the onset of surgery, particularly if they have not yet undergone a procedure that required anesthesia. While the surgeons will assuage fears about the procedure, it is the duty of the anesthesiologist to speak with the patient regarding the anesthesia itself. As anesthesia consultants and providers, anesthesiologists and CRNAs are in a critical role for quality of care. During this interaction, it is crucial for the anesthesiologist, or CRNA, to employ empathetic listening.

In addition to the humanistic benefits of listening, recent literature now suggests that listening to the patient may improve quality of care with regards to anesthesia. In Anesthesiology, Dr. Fleisher asserts that patient expectations towards care have changed, and patients now expect physicians to be receptive towards listening to patient concerns[2]. To achieve this aim, anesthesiologists should align with an institutional code of conduct that places the patient at the center of the listening paradigm. In this fashion, the anesthesiologist is guided to ask certain questions about the patient’s journey to the institution, his/her experience thus far, and expectations for his/her future health. This article underscores the importance of practitioner listening for high patient-reported outcomes, metrics which are increasingly important for hospital efficacy initiatives.listening

Along with strengthening the patient-provider relationship, practitioner listening is also crucial for increasing the patient’s comfortability with the treatment that will be administered through surgery. If the patient is satisfied by the explanations of anesthesia given by the practitioner, and has their questions listened to and responded to, the patient is more likely to be receptive to moving forward with treatment[3]. Moreover, the patient will leave their surgery with a favorable perspective of their anesthesiology provider imprinted in their memories, which is a benefit for post-operative patient satisfaction surveys that may be administered.

Based on the theory that physician listening directly correlates with patient satisfaction, a selection of healthcare scholars have proposed physician empathy as a cornerstone for patient satisfaction, to then be utilized to calculate fees in a pay-for-performance payment plan.[4] The American Society of Anesthesiologists, in particular, has a proposal in place to justify patient satisfaction as a legitimate basis for determining physician compensation, noting that a viable question to ask the patient is, “To what degree was the anesthesia team willing to listen to your questions?”. While the ability to include patient satisfaction as a metric for compensation and, accordingly, patient reimbursement, may differ per institution, the presence of such a mechanism exemplifies the importance of patient listening for quality of care.

In sum, the literature favors the philosophy that providers may improve anesthesia quality by listening to their patients. Furthermore, as healthcare professionals, anesthesiologists and CRNAs are critical to the delivery of empathetic, compassionate care — utilizing listening as a tool to achieve the aim of increased outcomes for all patients.

[1] AAMC. “Cultural Competence Education.” Association of American Medical Colleges, 2005, www.aamc.org/download/54338/data/.

[2] Fleisher, Lee A. “Quality Anesthesia: Medicine Measures, Patients Decide.” Anesthesiology, 2018, p. 1., doi:10.1097/aln.0000000000002455.

[3] Morrissey, Candice. “Patient Feedback in Anesthesiology Matters.” NEJM Catalyst, 2 Aug. 2017, catalyst.nejm.org/patient-feedback-anesthesiology-matters/.

[4] Anesthesia Quality Institute. Patient Satisfaction and Experience with Anesthesia. 2017. www.aqihq.org.

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