[Lack of communication between anesthesiologists and surgeons: comparison of questionnaire survey among anesthesiologists with that among surgeons concerning pre-anesthetic evaluation of surgical patients].

We conducted a survey to examine surgeons' opinions and criticisms of patient evaluations done by anesthesiologists prior to surgery. We sent questionnaires to 117 departments of general surgery in Japanese university hospitals. We received answers from 77% of the departments. We analyzed their answers, and compared the answers with those from a similar survey done in 1995 by Japan Society of Anesthesiology, one in which anesthesiologists were asked to evaluate themselves. Our most significant findings were as follows. (1) Although most of surgeons were satisfied with their own preanesthetic evaluation of their patients, 30% of the departments reported postponement of surgery due to the need of further examination during recent 2 months and the occurrence of peri-operative myocardial infarction during recent 2 years, (2) The 1995 survey indicated that 46 percent of anesthesiology departments had explained the major perioperative risk, but a half of the 46% had done so without discussing the risk with responsible surgeons. Furthermore, the present survey showed that only 17% of the surgery departments had been aware of such explanation done by anesthesiologists. (3) One-third of the anesthesiology departments did not document the text of the preanesthetic explanation to patients. In our opinion, the final responsibility for the patient's peri-operative care is primarily the surgeon's at present in Japan, although each specialist including the anesthesiologist and the cardiologist should share the responsibility. If the anesthesiologist explain the major peri-operative risk to the patient without first obtaining the surgeon's permission to do so, the patient may become confused about who is responsible for his or her care. It should be made clear to the patient what responsibility each doctor has. It is also important that all explanations given to a patient and the consent to anesthesia given by a patient be properly documented. Japanese anesthesiologists and surgeons need to work far more closely together with regard to pre-anesthetic evaluation and explaining patients about their peri-operative risk.