A moment in medical school that left a huge impression on me was when we had chairman’s rounds with the department of medicine’s chair.  He was a renowned breast oncologist and researcher and described a bit of his process when interacting with a patient. The process he had developed over his years of experience was so fine-tuned that there was not a single movement, action, word, or breath that was wasted.  Not to say that it was rushed or disingenuous-actually quite the opposite.  He was just so in-tune to the patient’s experience that if he told a joke, it had a purpose.  If he touched the patient’s arm, it was a specific decision. There was a reason if he chose to stand versus if he chose to sit.

So what could have me thinking about this, almost 10 years later, working in a specialty that couldn’t be more different than academic breast oncology?

Anesthesiology is a weird specialty. It is often joked about being a specialty with very little human interaction. After all, the bulk of the care we deliver is when the patient is asleep. We have minimal long term follow up and no clinic of our own. It is exceedingly rare that a patient puts thorough research into, or requests a specific anesthesiologist (though it does happen, and I believe it speaks volumes about that anesthesiologist as a clinician).  Typically, the patient has found and developed a relationship with his or her surgeon, and the anesthesiologist, is frankly, whoever is assigned to that OR that day.

A key (and mandated by CMS) component of anesthesia care delivery is the pre-anesthesia assessment, or “preop.”  At this point, the anesthesiologist will review all the patient’s pertinent labs and studies, speak with the patient about his or her medical history, and prescribe the anesthetic plan.  In our heavily flawed medical system, production pressures to do more with less time, also applies to anesthesia. This unfortunate trend, especially pertains to the preoperative evaluation, where we are expected to see more and more patients, in faster and faster intervals. Still, this is a critical opportunity in this compressed period of time, and one that is cited on residency applications all over the country, to develop a rapport and relationship with the patient, in what is likely one of the most terrifying moments of his or her life.

You’ll see a variety of styles in the way an anesthesiologist approaches this challenge.  One of my colleagues has the most soothing, calming, relaxing tone of voice I’ve ever heard. Another has such an undeniable sweetness that it immediately puts a patient at ease.  Some anesthesiologists use humor.  Some have good looks going for them (just saying, it’s been written on patient satisfaction surveys. Not mine, obviously). Some lean into an “aw shucks” Southern drawl. Some sit. Some stand.  Frankly, COVID has introduced new challenges to this process, given masking and socially distancing, that many are adapting to.

Personally, I’m still perfecting my style.  I’m not at the same unique level of intuition as that professor of medicine, who knows exactly what every patient needs.  Nevertheless, I can often discern it pretty quickly:

Some patients are hungry for information and want to know every detail. Others want to know as little as possible.  Some enjoy their sarcasm being matched. Others are far less likely to appreciate it.

But a strategy, that I’ve begun to incorporate, that I never in my life would have predicted, is arrogance.

To be clear, it’s a very specific type of arrogance.  It’s a very carefully deployed type of arrogance.  Perhaps a better terminology for it is extreme self-confidence.  It usually takes shape in this way:

I have a patient who is exceedingly nervous and/or is about to undergo a high risk or complicated procedure. I’ve given the patient and family as much or as little information as they desire. I’ve made my best joke (I know you’re shocked to learn that they don’t always land). I’ve made my best attempts to empathize and comfort, but they still seem ill at ease. So I say:  “I want you to know you’re in great hands. Because I’m basically the best anesthesiologist there is.”

And it is universally met with a sigh of relief, laugh, and smile.  Granted, there is usually a comment to the tone of “oh and so humble too!” But I think it’s well-received.

And while I definitely don’t think I am the best anesthesiologist there is, I do think I’m a pretty damn good one.  And I’m passionate about becoming better every day, doing right by my patients, and making them feel appropriately well taken care of.

Wouldn’t you want the same?

Stephen Freiberg is an anesthesiologist who blogs at The DADesthesiologist.

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