AJA Asian Journal of Anesthesiology

Advancing, Capability, Improving lives

Editorial
Volume 56, Issue 2, Pages 43-44
Wei-Zen Sun 1 , James L. Reynolds
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Anesthesiologists—as the term is used in the United States and through much of the world today— are physicians with specialized training and certification in anesthesia, perioperative medicine, pain management, and often additional subspecialties, such as sleep medicine, intensive care medicine, or critical care medicine. In the United Kingdom, Ireland, Australia, and several other areas—generally former territories of the British Empire except Canada—the term anaesthetist is used.1 A cursory survey of bio-science literature, some popular science journalism, and some mainstream or traditional media reveals some mixed practices elsewhere: In Germany, for example, anesthetist is sometimes used synonymously with the more commonly-used anesthesiologist for this meaning. 2

Indeed, the word anesthesia is spelled anaesthesia in “British English” and anesthesiology is spelled anaesthesiology.

These nomenclature differences alone are enough to cause confusion and doubt among English users around the world—not just among laypeople, but among anesthesiologists (and anaesthetists) themselves. We face an even wider and sometimes more frustrating set of confusions when we consider differences in the sets of roles and responsibilities associated with those who administer anesthesia to patients, those who work in perioperative and pain management medicine, critical care and intensive medicine, etc.

One “second-order” level of confusion entails the fact that even in the US and places that follow or essentially follow a US system, anesthetist is used in numerous different ways. Commonly, anesthetist is used (sometimes as shorthand) to indicate some kind of assistant or support person (for example nurse anesthetist), who must work under the supervision of an anesthesiologist, and in some places cannot administer anesthesia, but may only support and assist those who do).3,4 Second, anesthetist is sometimes used to refer to a person who is most directly or proximately administering an anesthetic to a patient, whether or not they are a physician; for example, an anesthesiologist in an operating suite may also be functioning as an anesthetist when they administer anesthesia. A trained nurse in some places may administer anesthesia under (some kind of) physician supervision. While in a remote area, underdeveloped area, wilderness area, or extreme situation, a general practitioner/ primary care provider, other medical or paramedical caregiver, or even a layperson with no training in anesthesia, might be the anesthetist in a certain emergency or improvised situation.

To clarify the idea that an anesthesiologist (when used as a term of personal-professional identity), might or might not be an anesthetist (when used as a term describing someone who performs certain actions), consider an example situation in a place where some non-physicians can and do directly administer anesthesia. At a given moment in a particular procedure interoperatively, an anesthesiologist (or anaesthetist in British English) may be supervising patient stability aspects while a non-anesthesiolo-gist—perhaps as in some parts of the US, a certified registered nurse anesthetist—conducts the hands-on administration of anesthesia. It is in this way possible for an anesthesiologist to be working but not as an anesthetist. This might be similar to a teacher enrolling in a seminar or workshop: That teacher is, in the situation, a student. Still a teacher, but not the teacher in that situation and at that moment.

Medical dictionaries provide definitions of anesthetist that range from a synonym for anesthesiologist (as well as noting that anaesthetist is “an anesthesiologist in the UK”)5 to “an anesthesia assistant”: definitions that range from vague or general to narrow and specific, and which sometimes contemplate training or certification, sometimes describe an activity, and sometimes a job title or function.

The issue of terminology with respect to people and practices in anesthesiology is not merely an interesting or vexing set of labelling complexities. Behind the terminology stand issues of central importance to people. These relate to policy questions that impact quality of patient care and safety, economics, scope of practice issues, medicolegal issues, politics, and matters of personal psychological importance: What we are called or what we call ourselves relates to issues of recognition, appreciation, and respect.

A current issue in Australia is an initiative to change official designations of physician-anesthesiologists from anaesthetist to anaesthesiologist. This after a survey of Australian adults showed that most do not know that anaesthetists were doctors. Comments on the article’s webpage vary widely: from assertions that few people know (or care) whether the person administering anesthesia or supervising its administration is a physician or not, to sarcastic expressions of false sympathy for doctors who are felt to make unjustifiably high salaries, to agreement that the highly-trained specialists are unrecognized and under-appreciated. Also, as one reader commented in protest of the name change: So many people have trouble spelling it now. What hope when they add another half dozen vowels?1


References

1
Dow A.
Sleeper sell: anaesthetists want name change so people know how skilled they are.
The Sydney Morning Herald.
2
Rügheimer E, Schwarz W.
Anesthesia training in West Germany.
J Clin Anesth 1991;3:249–252.
3
Bloom L.
Anesthetist vs. Anesthesiologist.
Chron. http:// work.chron.com/anesthetist-vs-anesthesiologist-6475. html. Updated July 1, 2018.
4
American Society of Anesthesiologists.
Types of careers in anesthesia.
American Society of Anesthesiologists. http:// www.asahq.org/resources/career-resources/anesthesia- as-a-career/types-of-careers-in-anesthesia. Accessed March 18, 2018.
5
“anesthetist."
McGraw-Hill Concise Dictionary of Modern Medicine. 2002.
https:// medical-dictionary.thefreedictionary.com/anesthetist.

References

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