Are patients and physicians honest with each other?
It is difficult to imagine the anxiety of a patient who is drifting away into the unknown and is at the careof (or perhaps even at the mercy of) a doctor  a stranger they know little of. As they slowly succumb to the anesthetic, the patient mulls over the horror stories theyve heard of sedation gone wrong. Even worse, they meditate on the now outdated studies they hastily found on Google that suggest around 1 in 200 patients will suffer from intraoperative awareness. And while operations all around the world continue to be successful, this patient is adamant on the fact that theyll be the outlier. After all, a physician who has no personal attachment to them is dragging them gently into a temporary lullaby. But for physicians worldwide, this isnt just a job  this is a high-wire walk toward a patients well-being, a tight rope getting stronger and sturdier thanks to decades of research. The concept of improving patient safety was created and popularized by anesthesiologists, with the field serving as a model for improving patient safety in health care. Operations are far safer now, though both parties inherent responsibility and anxieties persist centuries later. Today, advances in anesthetic safety involve evaluating failures and creating evidence-based strategies to prevent them in the future. Older guidelines focused on factors directly associated with anesthesia mortality and had limited scope regarding other facets of patient well-being. With our greater understanding of anesthetics administrations psychosocial aspects, current guidelines have a more multifaceted approach. However, while it is relatively straightforward to collect quantitative anesthetic outcome measures, such as duration of time under sedation, measuring certain side effects is subject to interpretation bias. Specifically, severe side effects, such as data on postoperative neurological symptoms, are self-reported by patients. The data suggests that the variability in risk disclosure practices can undermine the reliability and validity of patient-reported rates of postoperative neurological symptoms. Consequently, as the method of data collection is inconsistent, it is difficult to make meaningful conclusions from the evidence for this outcome. For instance, some patients are informed to report back to study investigators if they have any numbness or tingling in their fingers. However, other patients are told to report any neurological symptoms, with varying definitions depending on the physician in charge. Consequently, the data collected has a great deal of heterogeneity and depends on what the physician explained to the patient. The Declaration of Helsinki defined informed consent according to the following components: competency, disclosure, autonomy. These components inform surgery guidelines, including an ability to participate in care decisions, understand pertinent issues, and be free from others control in making decisions. However, if there is any doubt in the evidence informing the relevant issues, that can violate the tenets of informed consent. Consequently, we believe it is essential to have a structured and uniform approach to risk disclosure in trials evaluating adverse events in anesthetic administration to inform our clinical reality more accurately. In this vein, it is crucial to re-evaluate the state of evidence on neurological deficits, especially with the lack of consistency in these studies. It is also essential to inform patients undergoing anesthesia that neurological deficit data might not be accurate. In the future, this honest revelation on the state of evidence is fundamental for developing strong patient-physician relationships. As we return to our patients, we notice that there appears to be a relative calmness where there once was trepidation during their emergence. With the patient awake, the physician inquiries about their experience. The physician, now at the mercy of the patients criticism, takes note of what they felt. Just as the physician was responsible for being transparent with their patient, the patient suddenly realizes the weight their transparency holds over the next patient who takes their hospital bed. A relationship that initially felt one-sided  with the physician at first hovering over the vulnerable patient  now becomes something in tandem, meant to improve both sides of the experience. If one is transparent with the other, then risks can be minimized, and successes can continue to rise. Surgery continues to be safer than it was in the past. While the relationship between a doctor and their patient could be improved, patients can rest easy knowing that centuries worth of research has focused on giving them the optimal experience.