In recent years, the medical literature has increased the emphasis on patient-provider relationships. In the context of this relationship, it is critical for the provider to practice empathy with their patients, as exemplified by the art of listening. The importance of listening in medicine is underscored through its newfound emphasis in medical training. In fact, the governing body for medical education, the Association of American Medical Colleges, has published guidelines that list empathy as a critical skill for future physicians to employ in their practices. The AAMC directs that by the conclusion of medical school, students should value curiosity, empathy, and respect in patient care.[1] Listening as a form of empathy is thus increasingly important for healthcare practitioners. Physicians and allied health professionals alike should have the ability to hear their patients’ concerns, empathize with the emotions that structure these concerns, and respond adequately within the lens of the patient’s state at that moment in their healthcare episode. Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) are particularly well suited to be involved in initiatives concerning listening and empathy. Many patients may present with anxiety about undergoing surgery under anesthesia, particularly if it is their first time. While it is the role of the surgeon to lessen the patient’s nervousness about the procedure, it is the duty of the anesthesiologist to communicate with the patient on the process of anesthesia itself. As anesthesia service providers, anesthesiologists and CRNAs are in a unique role to enhance quality of care. During their time with patients, it is critical for the anesthesiologist, or CRNA, to practice empathetic listening.
Along with the goodwill benefits of listening, the academic literature now suggests that listening to the patient may improve anesthesia-based quality of care. In Anesthesiology, Dr. Fleisher asserts that patient expectations towards their medical care have changed in recent years; many patients now expect healthcare providers to be receptive towards listening to their individual concerns[2]. To achieve this objective, anesthesiologists and CRNAs should consider aligning with an institutional code of ethics that places the patient at the center of the listening paradigm. In this mechanism, the anesthesia care provider is encouraged to communicate with the patient through a guided narrative, e.g. to ask specific questions about the patient’s journey to the institution, the healthcare experience thus far, and expectations for his/her future healthcare decisions. This article strengthens the argument for the practitioner listening as a variable leading to better patient-reported outcomes and quality metrics, which are increasingly important for hospital-wide initiatives.
In addition to addressing a strong patient-practitioner relationship, anesthesia provider listening is also important for enhancing the patient’s baseline comfort with the surgery. If the patient is adequately satisfied by the description of the anesthesia process, and has their outlying questions listened and responded to, the patient is more likely to be amenable to moving forward with treatment[3]. Furthermore, the patient will exit the hospital with a favorable perception of their perioperative experience, which is an advantage for patient satisfaction surveys that may be administered following their visit to the healthcare institution.
Driven by the theory that practitioner listening is directly correlated to patient satisfaction, a subset of healthcare scholars have proposed physician empathy as a foundation for patient satisfaction, to then be applied to, for example, the calculation of fees in performance-based health plans.[4] The American Society of Anesthesiologists, in fact, currently has a proposal in place as proponents of patient satisfaction as a basis for determining physician compensation. They propose asking the patient, “To what degree was the anesthesia team willing to listen to your questions?”. While every institution is in degrees of transition with regards to including patient satisfaction measures for compensation and reimbursement determination, the rise of this metric in healthcare literature underscores its importance for quality.
To conclude, the recent literature advocates that anesthesia providers may improve quality of care by listening to their patients. As healthcare professionals, anesthesiologists and CRNAs can serve as ambassadors to the delivery of empathetic, compassionate care — with listening to the patient at the center of their care philosophy.
[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.