In his lucid editorial on the evolution of confidential enquiries into maternal deaths, Yentis rightly complains that no anaesthetist sat on the main panel overseeing the Maternal and Newborn Clinical Outcome Review . Furthermore he points out that while the Obstetric Anaesthetists’ Association (OAA) had submitted comments (unsolicited), other specialties such as obstetrics, paediatrics and midwifery (including their respective Royal Colleges) were actively consulted. Indeed, Yentis reveals that the Chief Medical Officer did not even respond to the letters of interest submitted by the Presidents of both the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland.
Yentis’ account parallels the omission of anaesthetic representation in an important document on the provision of services for children in emergency departments . While the Association and (College) of Emergency Medicine, Association of Paediatric Surgeons, Ambulance Liaison Committee, and Royal Colleges of General Practice, Nursing and Paediatrics and Child Health were all represented, no anaesthetic organisation was consulted.
We can only speculate on why anaesthesia has been marginalised in this way, but clearly the reasons for being ignored relate to how one is perceived by others. Such perceptions can relate to intangibles such as appearance, dress, accent and social class (all likely to be irrelevant in this particular case of marginalisation) [3-7]. However, one factor which we think highly relevant (and perhaps relates to ‘social class’ in a broad sense) is the striking fact that while representatives of all other organisations mentioned by Yentis (and that appear in the emergency department report ) can readily offer a ‘professor’ to represent their views, anaesthetics cannot. There is apparently only one UK ‘professor of obstetric anaesthesia’ (and possibly no professor of paediatric anaesthesia) and as a result, the public, government and other organisations and specialties have (quite logically) concluded that anaesthesia was only peripheral to the much more important issues that the Outcome Review Panel (and paediatric report) needed to discuss. Thus, the Outcome Review Panellists included a Professor of Midwifery (there are several hundred more professors of nursing and midwifery than there are professors of anaesthesia)  and another Panellist styles themselves ‘doctor’ on the basis of a professional studies degree. Readers may be amused by such use of titles, but in fact these forms are taken very seriously indeed by the wider public and by regulatory bodies. Furthermore, the strategic use of these titles by these individuals has helped further the influence of the specialties they represent.
Like the OAA, the Difficult Airway Society (DAS) is increasingly in contact with government, regulatory and other agencies on matters related to equipment and guidelines, and we have also noted the lack of UK professors to represent our views. However, we have now committed ourselves to take matters into our own hands (as we are entitled to do) and rectify this anomaly. Our strategy is now detailed on our website (see: www.das.uk.com) and we urge readers to study this and provide us with feedback (especially if they are DAS members). Our strategy will help to ensure that DAS will be viewed from outside the specialty as an equal player, on the same level playing field as are nurses, midwives and other influential policy makers. We have no intention of being marginalised in future national enquiries into matters of relevance to us, in the way that obstetric anaesthetists have been in this instance of the Maternal and Newborn Clinical Outcome Review. We also urge other anaesthetic organisations to follow suit and – preferably working in unison – start the process of awarding titular professorships of anaesthesia to their suitably qualified members.
Jaideep J Pandit
Consultant Anaesthetist, Oxford & Scientific Officer, DAS
Consultant Anaesthetist, Reading & Secretary, DAS
Consultant Anaesthetist, Dublin & President, DAS
No external funding and no competing interests declared.
- Yentis SM. From CEMD to CEMACH to CMACE to...? Where now for the Confidential Enquiries into Maternal Deaths? Anaesthesia 2011; 66: 859-60.
- Intercollegiate Committee for Services for Children in Emergency Departments. Services for Children in Emergency Departments. The Royal College of Paediatrics and Child Health: London, 2007.
- Lev-Ari S, Keysar B. Why don't we believe non-native speakers? The influence of accent on credibility. Journal of Experimental Social Psychology 2010; 46: 1093–6.
- Bickman L. The social power of a uniform. Journal of Applied Social Psychology 1974; 4: 47-6 1.
- Morand DA. Forms of address and status leveling in organizations. Business Horizons 1995; 38: 34-9.
- Hennessy N, Harrison DA, Aitkenhead AR. The effect of the anaesthetist's attire on patient attitudes. The influence of dress on patient perception of the anaesthetist's prestige. Anaesthesia. 1993; 48: 219-22
- Swinhoe CF, Groves ER. Patients' knowledge of anaesthetic practice and the rôle of anaesthetists. Anaesthesia 1994; 49: 165-6.
- Pandit JJ. Measuring academic productivity: don’t drop your ‘h’s’! Anaesthesia 2011; 66: 861-4.