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Anaesthetist v Surgeon – Positive or Negative?

Today I am going to take a semi-serious look at the, sometimes fractious, relationship between anaesthetists and surgeons, one of the key professional partnerships in medicine. As a surgeon myself, specialising in Urological cancers, I have to say that some of my best friends are anaesthetists and their contribution to successful patient outcomes is vital.

Nonetheless, much is made of the supposed rivalry between these two specialisms. It is perhaps heightened by the fact that they are the key players in a surgical team and neither can work without the other. Both are used to working under pressure in often stressful situations, very likely to be Type A personalities and be obsessive about detail. Conflict at some level is to be expected.

Recently research into conflict situations between surgeons and anaesthetists was carried out by the Department of Anaesthesia at Vall d’Hebron Hospital in Barcelona. The objective was to identify the main situations that lead to conflict and their causes.  After surveying all anaesthetist departments in Catalonia the key findings were:

• 60.7% of anaesthetists had had arguments with surgeons
• 33.3% averaged an argument a month
• 21.4% averaged one a week

The most frequent cause was exceedingly long surgical programmes. 95.8% of anaesthetists considered that surgeons try to operate elective cases in the Emergency operating theatre on the day when they are on call. The third most common cause of arguments was due to constant complaints by surgeons that the patient was not relaxed enough. The fourth was whether or not to go ahead and operate. Across the board conflict was found to be most common in emergency situations.

Given the source of the research the emphasis is understandable but does illustrate how vital it is to maintain great team work in the operating theatre, to let opinion be heard but not to let ego’s impact patient care.

Common medical stereotypes would picture the anaesthetist as the brains of the operating theatre with the surgeon as the brawn – hence the suggestion that Orthopaedic surgeons are “as strong as an ox and almost twice as clever”. The British Medical Journal did some research into this view in 2011, comparing the intelligence test scores and grip strength of 36 orthopaedic surgeons and 40 anaesthetists, both male, at three UK district hospitals. The results showed that both mean grip strength and intelligence test scores for the surgeons were higher than the anaesthetists who should now find new ways to make fun of their friends,

It is often said that if you want to find a good surgeon ask an anaesthetist. My feeling is that professional rivalry, points of view clearly expressed and sharing a common objective are what make for high performing surgical teams and that is what we all want – surgeon anaesthetist and patient.

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