Communication Skills for Anesthesiologists
Prof.Sekar Michael M.D.,D.A.,DNB
Prof & HOD, Anesthesiology & Pain Services
Institute for Communicative and Cognitive Neuro Science & Research
Shornur, Kerala
Every species in this world communicate with others by some methods. Human beings are the best among all as they converse in many modalities like expression, sound, vocabularies etc. We, the Anesthesiologists need to be well versed in communicating skills as we play a pivotal role in operating rooms, emergency suits and intensive care units. We act as a spokes person for the surgical team to convey the message to the medical units and vice versa. Since operating and Non-operating procedures are done by a team of people, we happened to be the decision makers and obviously the margin of error is so thin that we cannot be casual in our approach. Some may say that it is an art, inherited in one’s life but many agree that the skills could be developed by anyone who wishes to be a good narrator. It definitely enhances our practice and more importantly it improves the patient outcome1.
Basic Aspects: 
A good relationship starts with good communication, but the question is what we mean by that! Obviously it is not just conveying a message with a few vocabularies. The message has to be delivered clearly, received successfully and most importantly it should be understood completely. Though we use verbal communication to convey the message we add tone, pitch, pace, gesture, body language, facial expression and possibly eye contact. Every one of us has these things within us, and developed over a period of time. It may vary with the circumstance where we are brought up and groomed. Some people may say it more with less expression and a few may insist more on expression with less vocabulary.  However, it is our responsibility to speak what we want to say completely, not others to figure out what we mean by reading between the lines. 

Learning Barriers:
India is so diverse in culture and language. Though we study our subject in English, our thinking process used to be in our mother tongue and most of them are totally different. Could language be a hurdle for our communication deficits? Can a person with good knowledge of language express his opinion well? The fact is a literal knowledge and oratory fluency alone cannot guarantee a good expression. Could it be due to the knowledge of our subject? It is obviously a big concern though, it can’t be relied entirely. A person with good understanding of the situation will be in a better position to express what he thinks to an extent. Unfortunately our medical curriculums do not insist on skill development training.  Many medical personnel develop their interpersonal relationship after starting their clinical practice as it is a compelling aspect to build their carrier. As anesthesiologists are restrained themselves within four walls throughout the day, they miss the chance of interacting with many. Our relationship with patients and their relatives too are diminishing mainly due to the work load. In contrary we are expected to communicate many issues with the patient right from the risk stratifications to post operative pain relief. 
Uniqueness o f Anesthesia:
There are many aspects in anesthesia specialty make anesthesiologist as a unique person among the medical professionals. Our relationship with the patient is very short but we are expected to know them better. We get to know them just a few days or hours earlier and try to understand them and the disease they are suffering from. Though the incidence of complications is less in modern anesthesia, it is the mortality especially in neonate and children, which makes us to be on our toes throughout our life2,3. Good communication is the bridge between confusion and clarity. Anesthesiologists are expected to have good knowledge in Medicine as well as Surgery. We get opinion from various specialists regarding the patient’s disease status and stratify the risk involved in the procedure. It is on the onus of the concerned anesthesiologist to explain the risk status to the surgical team as well as the patients.  By doing so, we happened to be the decision makers for the entire proceedings. After all our communication skills act to facilitate relationship, to build and maintain team structure4. We have to narrate the proceeding as a whole to the patient and his care takers before getting consent. Our relationship has to be cordial and the same time very clear to the following;
1.	Surgeon and his team
2.	Specialists who screen the patient pre-operatively
3.	Nurses and technical assistants of the operation room, ICU and causality 
4.	Patients and their by standers
Surgical team:
Understanding the nature of procedure and its outcome is so important to estimate the risk and plan for anesthesia accordingly. It is better to listen to the surgeon and make your doubts clear well ahead of the proceedings. An open conversation, if possible at the bed side during the pre operative rounds may be helpful for the patient to have an idea. Post operative instructions are to be conveyed clearly at the end of the procedure.
Specialists who screen them Pre-operatively:
Specialists who screen the patient may not have a thorough idea about the proceedings and give only opinion regarding the current status of the patient in his discipline. We are expected to gather information from experts and form our own opinion regarding the risk status. It is wise thing to clarify doubts and put it across the surgeon and patients as a nutshell. 
Nurses and technical assistance:
Anesthesiologists are the head of operation room, post operative wards and causalities in many institutions5. It is very important to make everyone to follow protocols especially in sterilization, infection control and emergency rescue operations. 
Patients and their by standers:
Patients and their by standers may not have a good knowledge about Medicine and Surgical procedures. It is very imperative to explain the nature of the procedure, anesthesia and its mortality. It is very unfair to tell them the possibilities of morbidity and mortality frankly with statistics which may not serve any purpose. But at the same time we should not hide any serious issues and give them a chance to decide on their own. 
Solving the Issues:
Solving these shortcomings is essential to improve the better outcome in health care. Skill development can’t be achieved over a short span of time and in fact it has to be inducted in our training period itself. We have a big responsibility to improve ourselves and our team. Certain principles may be very helpful to achieve the goals ;
1.	Have a thorough knowledge of the patient and his disease process.
2.	Good listener makes a good narrator, so listen to the surgical team and give your comments.
3.	Communicate with the team heads and its members clearly and firmly.
4.	Inform the patient just adequately and avoid very strong opinion regarding the outcome.
5.	Avoid unnecessary promises to the patients regarding the outcome.
6.	Respect all team members and encourage them to communicate with you so that many problems can be solved well ahead.
Conclusion:
Anesthesiologists are the head in many areas like operation rooms and critical care units where a team of people work together. The team head should have skills in communicating with all members so that the outcome of the procedures and management will be fruitful. 
“You can have brilliant ideas, but if you can’t get them across,
Your ideas won’t get you anywhere”.
~Lee Iacocca

Reference:
1.	Smith AF, Shelly MR; Communication skills for Anaesthesiologists. Can J Anesth 199; 46: 1082 – 8.
2.	Bainbridge D, Martin J, Arango M, Cheng D, Perioperative andanesthetic related mortality in developed and developing countries: a sysematic review and meta analysis. Lancet 2012, Sep 22;380(9847): 1075-81.
3.	Dora Catre, Maria,Francelina Lopez, Antonio Silverio Cabrita, Perioperative morbidity and mortality in the first year of life: a systematic review (1997-2012). Brazillian Journal of Anesthesiology, Sep-Oct 2015; vol 65(5):384-394.
4.	Fletcher G, Hofinger G, Buerschaper Crisis management in acute care settings; Human factors and team pshychology in a high stake environment, 2008; 152.
5.	Johannes Walker, Michaela kolbe, Leadership and team work in anesthesia – Making use of human factors to improve clinical performance. Trends in Anaesthesia and Critical Care; Dec 2014, Vol 4(6): 200-205.