Anesthesiologists: the mysterious masked doctors of the OR. It's no wonder that myths arise about us often unassuming, laid-back physicians -- even our anesthetics are mystifying! (It wasn't until last year that we could finally describe .) So, in honor of the physicians who care for patients at every age, from birth to death, during some of the happiest or scariest moments of their lives, it's time to weigh in (with a little help from my peers) on the biggest misconceptions about anesthesiologists.
Isn't anesthesiology just administering anesthetics? Anesthesiology is so much more than that! While administering anesthetics is an important component (and can be done by many types of clinicians), the heart of anesthesiology is the practice of medicine. As "the intensivist of the operating room," we make medical decisions and perform interventions based on our expertise as specialty-trained physicians, which extends into the intensive care unit, hospital wards, and pain clinics. Wondering how a heparin-allergic patient would go on cardiopulmonary bypass? Need to know how a child with Klippel-Feil syndrome and malignant hyperthermia could get surgery? Wondering if a device can be implanted in the spine to treat complex regional pain syndrome? These are all areas of anesthesiology expertise. There's a reason we accrue of clinical training before we practice independently.
Do anesthesiologists just sit around all day? Occasionally, we do sit down. But more likely, an anesthesiologist could be found anywhere in the hospital any time of the day or night -- perhaps in the labor and delivery suite placing an epidural for a pre-eclamptic mother, in the trauma bay attending to an elderly man's airway, or in the MRI suite anesthetizing an infant with seizures. We commonly supervise teams of anesthesia professionals in multiple ORs. I asked my peers their step count while supervising -- the answers ranged from 8,000 to 18,000. Yesterday, my friend, Dr. Ku, clocked over 15,000 steps supervising 3 ORs and managing anesthesiologist-in-charge duties. As new residents, my classmates and I underwent physiologic monitoring as part of a study: turns out we burned .
Do surgeons direct anesthesia care? While this trope is now relegated mostly to medical student forums and TV shows, it still gives anesthesiologists and surgeons a good chuckle. This myth is a relic of history: over 150 years ago, before anesthesiology became a medical specialty, the surgeon would delegate the (still dangerous) task of anesthetizing to the . in surgery and anesthesia, such as cardiopulmonary bypass, regional anesthesia, non-operating room procedures, trauma resuscitation, and more complex surgeries, have necessitated comprehensive expertise in anesthesiology. While the surgeon is tasked with performing the surgery, the anesthesiologist is tasked with keeping the patient alive, anesthetized, and pain-controlled -- two very different skill sets as a team.
Do anesthesiologists take a lot of breaks? There is a nugget of truth in : it is very obvious when anesthesia professionals take breaks. But why? For one, the person providing anesthesia is the only person in the OR who , even for a minute. Need to use the restroom, pump milk, or grab a coffee? You'll need a qualified anesthesia professional to cover you.
Secondly, while the surgical team usually takes breaks in the downtime between cases, this turnover time (in which the previous patient is emerging from anesthesia and being transported and recovered, and the next patient is being prepared for induction of anesthesia) is one of the riskiest periods in the anesthesiologist's workday. To use an aviation analogy: cruising is a much safer period than takeoff or landing.
Lastly, ; this is why your friendly anesthesia professional will announce the new team member taking over by name.
Do anesthesiologists dislike being called "anesthesia" instead of their real names? This one is true! In , only 28% of the OR staff knew the anesthesiology resident's name, but the anesthesia resident knew 82% of the OR staff's names. There's science behind why we care about everyone knowing each other's names: Atul Gawande, MD, MPH, who helped champion the World Health Organization Surgical Safety Checklist, estimates that team introductions prior to a surgery can reduce complications and deaths .
Is practicing anesthesiology 95% boring and 5% sheer terror? It may look like we're calm and collected managing a massive intraoperative hemorrhage, but before all that were the hours of quietly planning, where cross-matches were collected, intravenous lines were placed, units of blood were prepared, and the rapid infuser was primed. There's a reason "" is our motto and are our logos: we are always anticipating, even when things are going right. Our value is in prevention of operating room disasters, and when that's not possible, rapid resuscitation. With no ego, no fuss. Our field attracts and develops that are calm under pressure, resilient, prepared, and situationally aware -- which is great for patients and the team (especially during a pandemic), but perhaps obscures the level of cognitive and technical effort we invest into each case.
Why do people joke about blaming anesthesia? While anesthesiologists have been blamed for everything from , it's actually becoming more difficult to attribute poor outcomes to anesthesia care alone. In the 1940s, the death rate from anesthesia care was 1 in 1,000. In the 1980s, it was 1 in 10,000. As of 2016, it's roughly , despite more complex surgeries and higher-risk patients. From the , the amount and severity of claims against anesthesiologists dropped significantly, highlighting the significant improvement in patient safety. How did we do it? With advances in monitoring and equipment (e.g., , ultrasound, and video laryngoscopy), and through adverse event reporting, simulation, teamwork, and evidence-based protocols.
But we're not done yet. There is always room to improve the health, equity, and outcomes of patients. Anesthesiologists will continue to innovate, especially in optimizing patient care well before and after anesthetics are needed, whether in the ORs, labor and delivery, pain clinics, or hospitals.
(*Anesthesia gases and waste actually to global warming, and we are working to change that.)
is a board-certified anesthesiologist and pain physician. She would like to acknowledge Tristan Pearson for proofreading, and the dozens of women anesthesiologists who shared their expertise for this piece. Pearson receives honoraria from the Anesthesia Patient Safety Foundation (APSF), which was not involved in this publication. The views represented are solely those of the author.