Professionalism in Anaesthesia, Intensive Care and Pain Medicine Report

The Professionalism in Anaesthesia, Intensive Care and Pain Medicine Report is a speciality specific guide to professionalism and ethics to sit alongside the Medical Council’s Guide to Professional Conduct and Ethics.

Download Professionalism in Anaesthesia, Intensive Care and Pain Medicine Report (pdf).

President Kevin Carson provides a foreword for the report as follows:

“Professionalism is the cornerstone of professional integrative practice that has its roots in a robust training and education, underpinned by current and innovative research, scrutinised by appropriate tests of knowledge and competencies to ensure the highest standards of patient safety throughout the discipline and related specialties in the operative department, intensive care unit, pain clinic, PACU and the wards. Anaesthetists are recognised as natural team leaders, moderators and good decision makers. They work well in teams, providing support for their non-anaesthetic colleagues but can also assist each other sharing specialist knowledge and skills. We should respect other colleagues, interacting with them professionally.

Anaesthetists care for patients from the time of contemplation of surgery to their discharge home and beyond as such and may be regarded as perioperative physicians. Consultant anaesthetists make up approximately 12% of the consultant workforce in Ireland and is the largest in-hospital speciality. Anaesthetists will engage with almost 70% of patients during their clinical pathway in the hospital setting. Through anaesthesia, critical care and pain medicine, we are challenged to deal with such di cult areas as breaking bad news and end of life issues, which must be treated with due assiduousness, respect and diligence.

The doctor patient-relationship is a fundamental unit of care and interaction and it demands integrity, altruism, compassion, patience, respect, tolerance and an understanding of diversity. Excellent communication skills, including the ability to listen, and recognition of the anxious patient with the ability to allay their fears are essential. We have a duty to preserve patient con dentiality not only undertaking not to divulge con dential information but also to ensure written information and data is kept in a secure manner.

Dealing with patients whose treatment has had an unpredicted outcome can be challenging, but must be dealt with empathically by senior, appropriately skilled anaesthetists and intensivists, embracing the tenets of open disclosure, acknowledging and apologising for adverse outcomes.

In pain medicine, discussing chronic pain issues, the rami cations of pain behaviour and therapeutic options, as well as their limitations, demands special skills. We must be advocates for our patients, bearing in mind that some will be at both extremes of life and possess the “quietest voice” in the room. As patient advocates, it is our duty to listen, carefully and fully explain the benefits and risks of procedures.

At all times, we strive to uphold and cherish the dignity of those in our charge. We aim to treat pain and su ering in all areas of practice, peri-operatively, in ICU and though the speciality of pain medicine. Symptom relief may supress vital re exes, but we must never set out a priori, or with the aim, to shorten or extinguish life. However, at times withdrawal of life-support, in an arena of futility, may be the appropriate therapeutic choice.

The Advanced Healthcare Directives have now been introduced into Irish law as part of the Assisted Decision Making (Capacity) Act 2015. These will provide a roadmap for patient’s healthcare choices, so we can treat them in accordance with their “will and preferences”. While the apothegm of the speciality is patient safety, we also have a duty to “those who watch” – the anaesthetists and intensivists themselves. Wellness and mindfulness, self-care and that of colleagues is a fundamental principle of professionalism. We are dedicated to on-going education, life-long learning, to maintain our knowledge and skills at the highest level.

As specialties of Anaesthesia, Intensive Care and Pain Medicine, we are committed to the three pillars of professionalism: partnership, practice & performance. As a College, we purport that these are continually revisited in a structured way through a specialised curriculum from medical school, through specialist training and throughout one’s career as a specialist to ensure the highest professional conduct at all times.”