The Anesthesiologist-Surgeon Relationship

Partnerships to optimize patient care exist between patients and medical suppliers, governments, health care professionals and patient organizations.¹ Within a group of health care professionals, collaboration entails working with providers of the same or other professions.² The relationships between health care professionals on a patient’s team can be crucial to the patient’s success.² Collaborative efforts include role clarity, trust, confidence, strength in the face of adversity, ability to overcome personal differences, and collective leadership.² These guidelines for an effective interprofessional relationship extend to the anesthesiologist and surgeon, who must often work together to ensure good outcomes for a patient.³ Even before they begin their training, anesthesiologists need to consider their role in the operating room (OR), their relationship with the attending surgeon, and the possible ramifications of OR conflicts.

According to Dr. John Bunker, the founder of the Department of Anesthesia at the Stanford University School of Medicine,⁴ the anesthesiologist should function as “the internist of the operating room.”⁵ Though anesthesiologists may specialize in anything from palliative medicine to critical care, many anesthesiologists provide anesthesia to patients undergoing surgery in an OR.⁶ In OR cases, the anesthesiologist prepares the patient for surgery, manages the patient’s pain control, anesthesia and vital signs during a procedure, and supervises postoperative monitoring and care related to breathing, circulation, oxygen level and pain management.⁶ The OR is a busy place, populated by surgeons, anesthesiologists or nurse anesthetists, surgical technicians and registered nurses.⁷ These professionals work in close quarters for many hours and deal with fluctuating workloads throughout surgery.⁸ Thus, mutual respect and relational coordination are important qualities in the members of a surgical team.⁹

The anesthesia provider and the surgeon are two members of the surgical team who have particularly integrated roles. In fact, the relationship between these two professionals has been a subject of study and written work for almost a century.¹⁰ Many health professionals consider the surgeon and anesthesiologist as partners in the care of the patient,⁵ and this extends throughout the entire perioperative period. During preoperative preparation, the surgeon, anesthesiologist and patient all meet to assess the patient’s health and ensure safety and efficacy of the anesthesia care.⁶ It is important that the anesthesiologist and surgeon show consistency and harmony at all times to reduce any possible anxiety for the patient.¹¹ Additionally, the anesthesiologist-surgeon dynamic must remain collaborative and respectful throughout the intraoperative period.¹¹ This may not only contribute to patient safety but also to the success of the entire surgical team.¹¹ The OR is a highly stressful and volatile place, and interpersonal conflict can be frequent and sometimes intense.¹² Postoperative care must also be assigned properly to both the surgeon and the anesthesiologist in order to prevent conflict and ensure quality of care.¹³ The anesthesiologist and surgeon work very closely throughout the perioperative period, and their relationship can affect a patient’s safety and satisfaction.

Despite a lack of research on anesthesiologist-surgeon relationships’ effects on patient outcomes, plenty of articles exist on the current state of such medical collaboration. According to a 2018 article by Cooper, some negative perceptions of surgeons by anesthesiologists include failure to know about medical or anesthesia-related issues, to acknowledge the extent of blood loss, to warn patients about difficult recoveries and to consider patient health conditions and patient desires.¹¹ Additionally, anesthesiologists may perceive that surgeons consistently underestimate surgical time and discourage speaking up about safety concerns by other professionals.¹¹ Meanwhile, some surgeons’ perceptions of anesthesiologists include that they are more concerned with finishing their day on time than serving their patients’ needs, unreasonably eager to cancel a procedure, unappreciative of schedule maintenance, distracted and inattentive during surgery, and unwilling to change the anesthetic approach for the surgeon’s needs.¹¹ Some other negative views include long turnover times, failure to communicate changes in vital signs or need for vasopressor support, and lack of understanding of the patient-surgeon relationship.¹¹ As found in a study by Nurok et al., surgeons and anesthesiologists may often misreport or misrepresent information to each other.¹⁴ According to personal accounts, anesthesiologists may feel that their importance to the surgical team is underrepresented to patients before, during, and after surgery.^13,15 For example, anesthesiologists may worry that multiple postoperative visits by the surgeons lead the patients to believe the surgeon is the only treating doctor.¹³ Indeed, despite the anesthesiologist’s key role in surgery, researchers and patients alike are more likely to connect the quality of a surgeon than the quality of an anesthesiologist with surgical outcomes.¹⁶ Though the anesthesiologist and the surgeon may have different values, their respect for each other and cooperation are vital to the success of the surgical team and the patient.¹¹

Health professionals must interact with each other and their patients in a variety of contexts and ways. The anesthesiologist plays a crucial role in surgery, involving close communication and collaboration with the surgeon before, during, and after surgery. Though a healthy anesthesiologist-surgeon relationship is highly important to patient safety and satisfaction, anesthesiologists and surgeons have many negative prejudices against each other. Anesthesiologists may also feel undermined by their lack of representation in patient care and outcomes. Future research should explore the influence of the anesthesiologist-surgeon relationship on patients’ morbidity and mortality outcomes.¹¹

1.         Grouse L. Medical partnerships for improved patients’ outcomes—are they working? Journal of Thoracic Disease. 2014;6(5):558–563.

2.         Bosch B, Mansell H. Interprofessional collaboration in health care: Lessons to be learned from competitive sports. Canadian Pharmacists Journal. 2015;148(4):176–179.

3.         Orlovich D. The Unique Surgeon & Anesthesiologist Relationship. Physician’s Weekly December 1, 2016.

4.         Newby K. John Bunker, Anesthesia Department founder and health-care critic, dies at 92. Stanford Medicine News Center May 31, 2012; http://med.stanford.edu/news/all-news/2012/05/john-bunker-anesthesia-department-founder-and-health-care-critic-dies-at-92.html.

5.         Callaway W. The Anesthesiologist and the Surgeon: Partners in the Operating Room. JAMA. 1972;222(10):1315.

6.         American Society of Anesthesiologists. Role of Physician Anesthesiologist. When Seconds Count… Physician Anesthesiologists Save Lives 2020; https://www.asahq.org/whensecondscount/anesthesia-101/role-of-physician-anesthesiologist/.

7.         Time F. Roles of Operating Room Personnel. The Houston Chronicle. Web: Hearst Newspapers; 2020.

8.         Barratt CC, Schultz MK. Staffing the Operating Room: Time and Space Factors. JONA: The Journal of Nursing Administration. 1997;27(12):27–31.

9.         Tørring B, Gittell JH, Laursen M, Rasmussen BS, Sørensen EE. Communication and relationship dynamics in surgical teams in the operating room: An ethnographic study. BMC Health Services Research. 2019;19(1):528.

10.       Henderson VE. Relationship Between Anesthetist, Surgeon and Patient. Anesthesia & Analgesia. 1932;11(1):5–11.

11.       Cooper JB. Critical Role of the Surgeon–Anesthesiologist Relationship for Patient Safety. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2018;129(3):402–405.

12.       Katz JD. Conflict and its resolution in the operating room. Journal of Clinical Anesthesia. 2007;19(2):152–158.

13.       Bajwa SJS, Takrouri MSM. Post-operative anesthesia rounds: Need of the hour. Anesthesia, Essays and Researches. 2013;7(3):291–293.

14.       Nurok M, Lee Y, Ma Y, Kirwan A, Wynia M, Segal S. Are surgeons and anesthesiologists lying to each other or gaming the system? A national random sample survey about “truth-telling practices” in the perioperative setting in the United States. Patient Safety in Surgery. 2015;9(1):34.

15.       Anonymous. The secret life of an anaesthetist: If surgeons are the blood, we are the brains. The Guardian. Web: Guardian News & Media Limited; September 12, 2016.

16.       Gerstein NS, Petersen TR, Ramakrishna H. Evaluating the Cardiac Anesthesiologist’s Role in Surgical Outcomes—A Reappraisal Based on Recent Evidence. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(1):283–290.