A Growing Transparency in Medicine

The provision of health services has been transforming from a largely top-down, paternalistic model into a construct in which patients play a substantive role in decision making over their care. Two articles in this month's issue of Anesthesia & Analgesia and an accompanying editorial address the growing momentum behind transparency in health care. Firstly, Quinonez et al consider the increasing expectation of family presence during surgical procedures and resuscitation of loved ones. They entertain the valid merits of family presence, such as the anxiolytic effect it may have as well as increased understanding of procedural goals and enhanced staff professionalism. Conversely, family members may not be psychologically prepared to bear witness to more invasive clinical environments and may serve as a source of distraction to providers. The impact of family presence on medical litigation is unclear. There have been long standing precedents set by way of obstetric and pediatric populations as seen in this infographic. In conjunction with the increased desire for physical presence of loved ones during clinical procedures, so too is there a demand for complete access to all medical records, including even the arcane hieroglyphics of an anesthesia record as detailed by Ramaswamy et al. As federal law now mandates such access, questions naturally arise as to their utility and medicolegal implications. The reader is strongly encouraged to review the concepts elaborated in these articles for in depth appreciation of their considerations.