A response to ‘Improving anaesthetists’ communication skills, Harms C, Young J R, Amsler F, Zettler C, Scheidegger D and Kindler C H, Anaesthesia 2004; 59: 166–72

I wish to congratulate the authors on their attention to a neglected but potentially important aspect of anaesthetic peri-operative care. The inability of communication training to improve patient outcomes is attributed to a series of factors which did not include the fact that the communication taught to anaesthetists might have been suboptimal in helping patients relax or feel comfortable. The objectives of the study were stated as improving interpersonal skills of anaesthetists and patient participation rather than improving patient outcomes. It is well recognised in the hypnotherapy literature that therapeutic communications, both verbal and non-verbal (frequently called suggestions) can radically change a person's cognitive beliefs, mood and behaviour [1]. Some anaesthetists may use such hypnotherapeutic language as part of their patient communication but few will have studied why some forms of language are effective in helping patients relax while other communications or explanations may actually increase anxiety [2,3]. An example follows of how one might communicate some information following introducing oneself as the anaesthetist: ‘I am here to put you to sleep for your surgery’ implies subconsciously that the patient might not wake up. One could, however, give the positive suggestion: ‘I am here to ensure your comfort and safety during surgery for when you wake up in recovery’. The implication here is that the patient will be safe, unconscious during surgery, wake up in recovery and might even be comfortable! Forty years ago, Egbert performed a landmark double blind study of 97 patients having elective abdominal procedures [4]. All study participants received a routine visit from the anaesthetist. Following randomisation, the intervention group were given pre-operative counselling and suggestions about what to expect and how to deal with postoperative pain after surgery. The positive suggestion/explanation group were able to reduce their narcotic consumption postoperatively by half and were discharged from hospital 2.7 days earlier than controls. Stress is recognised as a factor in increasing receptiveness to suggestion [5] and patients frequently have no conscious recollection of what is said at the time of the anaesthetic visit [6]. Too often, this partial amnesia is used as a reason for diminishing the importance of anaesthetic communications, when in fact, patients may be at their most receptive to suggestions both positive and negative, at this time. All forms of communication are areas where there is a clear need for increased attention and further study from the anaesthetic community.