Continuity

One of the often cited downsides of anesthesia is lack of patient continuity, and this is true. Anesthesiologists focus primarily on the intraoperative period and although we see patients pre-operatively and check them post-operatively, we don't see them over extended periods of time. We don't develop the close long-lasting relationships enjoyed by primary care physicians or pediatricians or even surgeons. We are a very episodic kind of physician, sort of like an emergency medicine doctor.

ICU, on the other hand, has some continuity. We see patients day after day, charting their progress, applauding their advances, struggling with setbacks. Even after patients leave the ICU, we try to check on them because there is a sense of ownership; this is my patient who I manged for a week in intensive care. We get to know families, especially in stressful and crisis situations. They learn to trust us, depend on us, or challenge us.

From a professional sense, continuity is crucial. It is medically important to know how each decision we make influences a patient's hospital stay or long term health. The tragic thing about anesthesia is that there are many ways of doing an anesthetic, but we don't always see the extended post-operative course. When we drop a patient off in the PACU, it's too early to know whether our tweaks make a difference. But they do; only with continuity do we understand how our anesthetics influence postoperative pain or nausea or time to recovery.

From a personal standpoint though, it is so much easier not to be in a field with constant continuity. When I am on a pure anesthesia rotation, I don't go home with anxiety, I don't stress at night about patients. But now in the ICU, I am constantly thinking, second-guessing, and following-up on my patients. I send late-night pages to the on call person. I feel incredibly invested in the care. And although this is ideal from a medical standpoint, I can tell you, I don't sleep as well. I don't feel as good.