Editor—Simini and Bertolini describe European practice that may not be relevant to the United Kingdom.1 For example, in the Netherlands doctors (internists) are under economic pressure to assess patients independently, in that they can charge the ziekenfonds (insurance company). In Groningen, although it was uncommon for the assessing anaesthetist to go on to anaesthetise the patient, two practitioners had always assessed the patient.
We recommend that the anaesthetist who assesses the patient should ideally give the anaesthetic, but this would mean no place for pre-anaesthetic clinics, which are already established in this country.
If a junior has assessed a patient and then assists the senior anaesthetist, the question then arises whether this qualifies as one anaesthetist, one patient. In one hospital in this country, a junior is the only person to assess the patient, the night before.
Internal audit in this hospital has shown that patients are more satisfied if they have seen an anaesthetist before. It is, however, difficult to quantify this benefit. A critical incident can only be linked to lack of assessment if the reporter is determined to incriminate himself. In Manchester the point of assessment has radically changed as children are now commonly clerked by a nurse practitioner before operations.
The authors favour the “one patient, one anaesthetist” model. In view of the pressures of an insurance based system and also the outside pressures of the European working time directive, we may be advocating a quality measure that is impossible to fulfil.
Competing interests: OD is an elected Council Member of the Royal College of Anaesthetists. The views expressed here are his own.
References
- 1.Simini B, Bertolini G. Should same anaesthetist do preoperative anaesthetic visit and give subsequent anaesthetic? Questionnaire survey of anaesthetists. BMJ 2003;327: 79-80. (12 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]