Why Compassion and Advocacy Are Essential in Anesthesiology
Compassion in anesthesiology directly reduces postoperative pain through anxiety-mediated pathways and significantly improves patient experience metrics, while advocacy positions anesthesiologists as critical leaders in preventing unnecessary surgeries, optimizing high-risk patients, and coordinating multidisciplinary care that reduces mortality and complications across the entire perioperative continuum. 1, 2
Direct Clinical Impact of Compassion on Patient Outcomes
Higher anesthesiologist compassion during preanesthesia interviews is associated with measurably lower postoperative pain scores on the day of surgery, with mediation analysis demonstrating that compassion reduces pain through an anxiety-mediated pathway, accounting for 9% of the total effect on pain reduction. 1 This translates to a significant average drop in pain scores of 0.02 to 0.13 points when compassion increases. 1
Beyond pain reduction, compassionate care correlates strongly with improved patient experience metrics (correlation coefficient ρ = -0.53), addressing what patients consistently rank as their highest priority across all phases of anesthesia care: information and communication. 1, 3 Notably, anesthesiologists often undervalue the importance patients place on communication during preoperative and intraoperative phases, creating a gap between what physicians think matters and what patients actually need. 3
Advocacy as a Core Leadership Function
The American Society of Anesthesiologists emphasizes that anesthesiologists must use the surgical experience as the first touchpoint to reengage patients in their own healthcare, coordinating with multiple stakeholders to improve outcomes while reducing costs. 2 This advocacy role is not optional—it represents a fundamental responsibility given anesthesiologists' unique position interacting with patients across the entire surgical continuum and their expertise in acute physiology, risk assessment, and crisis management. 2
Preventing Inappropriate Surgery Through Advocacy
Anesthesiologists must advocate by partnering with surgeons to present a united front when counseling patients about realistic postoperative expectations, particularly for high-risk patients whom surgeons may feel pressured to operate on despite poor surgical candidacy. 2 Many surgeons receive referrals where they recognize patients are not reasonable surgical candidates but feel "pushed into" surgery by patients, families, or referring physicians who don't understand the serious postoperative complications that anesthesiologists routinely witness. 4
By advocating for "surgical pauses" in high-risk patients requiring preoperative optimization, anesthesiologists can reset expectations and prevent surgeries that would result in mortality or devastating complications. 2 This advocacy ultimately reduces costs through complication avoidance while increasing profit margins, even if it reduces revenue in fee-for-service systems. 4
Advocacy for Vulnerable Populations
Cultural competency training is mandatory for anesthesiologists to address both explicit and implicit biases that cause diverse patient populations to receive less timely evaluation, monitoring, and appropriate treatment despite presenting with similar or higher-risk symptoms. 5 This advocacy requires implementing standardized protocols that reduce opportunities for bias to influence clinical decisions. 5
Anesthesiologists must advocate against rationing surgical or critical care based on age alone, while actively participating in discussions about the utility of surgery for individual elderly patients who face the highest risk of postoperative delirium and cognitive dysfunction—complications that anesthesiologists often fail to routinely screen for despite their frequency. 2, 6
Advocacy Through Multidisciplinary Leadership
Anesthesiologists should lead comprehensive preoperative assessment clinics that evaluate frailty, cognitive status, nutrition, chronic pain, substance use, and mental health—advocating for holistic patient preparation beyond traditional cardiopulmonary assessment. 2, 4 This leadership role involves coordinating with surgeons, primary care providers, and specialists in shared decision-making approaches. 2
Advocacy extends to postoperative care, where anesthesiologists must champion evidence-based protocols including early mobilization, multimodal opioid-sparing analgesia, and appropriate opioid prescribing at discharge to address the opioid crisis. 4, 7 Anesthesiologists can impact public health by being engaged in improving cognitive recovery after surgery and addressing opiate-related complications. 7
The Relationship Between Compassion and Team Safety
The surgeon-anesthesiologist relationship is the most critical element of overall team performance for patient safety, and a dysfunctional relationship can promote unsafe conditions contributing to adverse outcomes. 8 Compassion facilitates this relationship, enabling the teamwork now recognized as essential for safe, high-quality perioperative care. 8
Quality anesthesia care must focus on what patients want and deserve: improved patient-oriented outcomes and satisfaction. 7 By listening to patients and being engaged in the entire perioperative process through compassionate communication and advocacy, anesthesiologists make the greatest impact on perioperative care. 7
Common Pitfalls to Avoid
Do not underestimate the value patients place on communication and information provision, particularly during preoperative and intraoperative phases where anesthesiologists consistently undervalue these elements compared to what patients actually prioritize. 3
Avoid confining practice solely to the operating room when anesthesiologists' expertise in acute physiology and advocacy can add value throughout the perioperative continuum, preventing complications before they occur. 2
Do not assume that technical excellence alone defines quality anesthesia care—patients define quality through their experience, satisfaction, and outcomes, which are directly influenced by compassionate communication. 7, 1
Recognize that burnout impairs compassion delivery—implementing emotion regulation strategies including mindfulness, self-compassion, and resilience training is essential for maintaining the capacity to provide compassionate care. 9