Analysis of the clinical behaviour of anaesthetists: recognition of uncertainty as a basis for practice

Abstract

The dynamic complexity of anaesthesia sets specific requirements for the activity of anaesthetists. By exploring the significance given by anaesthetists to their work we have demonstrated a new conceptual framework and confirmed our hypothesis that there are differences in the orientations of anaesthetists, and that these become manifest in different types of clinical behaviour. We describe methods the anaesthetists use in framing the focus of their work, the patient in anaesthesia. The patient's uniqueness and uncertainty in anaesthesia were recognized in the 'realistic' orientation, which is characterized by an extensive use of situational information and an aim to construct a cumulative interpretation of a patient's physiological state. In the objectivistic orientation the patient was treated as a natural object and uncertainty was not recognized. This orientation is typified by a reactive habit of action which seemed to be based on a preoperative plan, and its deterministic implementation. Our results point to the need for a new strategy to cope with the uniqueness and uncertainty of actual problems. This has implications for education and practice in anaesthetic practice, since uncertainty is increasing with the ageing patient population and with implementation of new technology.