Current understanding of patients' attitudes toward and preparation for anesthesia: a review.
A number of issues relating to patient education in anesthesia have been addressed in this review and, based upon the available data, some questions can be answered clearly. It is apparent both that a large minority of the American, British, and Australian public is under the misconception that anesthesiologists are not physicians and that the role of the anesthesiologist, both in and out of the operating room, is not fully understood. Many surgical patients, particularly younger ones, have fears about the anesthetic that are distinct from their fears about the surgery, the most common of them relating to waking up prematurely or not at all. Traditional attire for anesthesiologists is preferred by patients but does not appear to significantly influence patient satisfaction. While there are numerous putative advantages to improving patient rapport, good communication as judged by the patient is associated with a lower incidence of malpractice litigation. Preoperative instruction has been demonstrated to have benefit with regard to patient anxiety, postoperative pain, and length of hospitalization. It is also clear that patients' coping behavior varies considerably and strongly influences the usefulness of providing detailed preoperative information. Preoperative teaching should therefore be tailored accordingly. An issue that is less clear concerns the optimal methods for educating patients and the general public. Preliminary evaluation of videotape instruction has yielded somewhat encouraging results, but whether the preoperative visit, supplemented by videotape or in-hospital, on-demand television programming, or computer networks, such as the World Wide Web or home television, are the most effective and practical means for this education remains to be seen. How best to identify in a cost-effective way patients who would most likely benefit from more information is an important question that remains relatively unaddressed. Advances in surgical diagnosis and treatment and critical care have depended upon the development of anesthesia as a specialty. Our ability to continue to develop may depend upon our success in educating the public, politicians, and other health care professionals about what we do. The evaluation of educational methods for disseminating information about anesthesia thus may be important in determining the very future of our specialty and the quality of surgical and pain therapy that patients will receive.