Anesthesiologists are faced with a unique dilemma. We must quickly establish rapport with patients about to undergo surgery – undoubtedly one of the most anxiety-ridden events in their lives. It’s an art that’s easy to spot but far more difficult to teach. Just how do we persuade patients to literally put their lives in our hands as we put them to sleep, place lines and tubes, administer drugs, and ensure their safety above all else? Here are a few of my strategies:
Before even saying a word to my patients, I like to “see” them in pre-op holding as I walk passed their bed to get IV supplies and fluids. This 5 second glance (not to sound like a creeper) gives me a lot of information about how they are coping with the prospect of surgery. Is the patient crying? Is he surrounded by family members? Is she agitated? Is he sleeping comfortably? Plus I get a quick peek at the baseline vital signs. This assessment from a distance helps me tailor how I’ll communicate with the patient in the coming moments.
I arrive at the bedside, shake the patient’s hand, introduce myself, and try to find a seat to be level with the bed. I think it’s far more foreboding to be towering above a patient when they are in such a vulnerable state. I also partly draw the curtain to maintain privacy.
In a cordial manner, I’ll clarify ambiguities and confirm details from their medical history. This lets the patient know that I’ve at least done my homework and know them in depth. I’ll review the consent form and see if they have any questions. In the mean time, I’ll start getting prepared to start an IV line +/- an arterial line.
The key to a good first impression is to get on the patient’s level… to actually listen to their concerns and explain things in a concise and simple manner. In the hustle-and-bustle pre-op area, patients feel at ease when a provider is focused on them 100%. Having reviewed their medical record and discussed an anesthetic plan with my attending the night before allows me to tailor the pre-op encounter accordingly.
The first question I ask most of my patients is how they’re doing at that moment. The majority express anxiety and stress. This is where I explain how it’s completely normal to feel a little stress before surgery, but reassure them that plenty of people (surgeons, anesthesiologists, nurses) will be directly involved in their case… and that a little Versed/fentanyl cocktail might take the edge off. 😉
I’ve also found that patients appreciate when you explicitly define your objectives around their safety. When I’m verifying or obtaining consent, I explain why we want to do each procedure (type of anesthesia, invasive monitoring, etc.) in the context of their safety. They care that you care.
Surgery is daunting. It’s like there’s no turning back once you’re in pre-op. Patients often lose their sense of control. I like to place them back in the proverbial driver’s seat by giving them options (especially to those who are very anxious). Would you like me to use numbing medication (lidocaine) before starting the IV? Do you want me to explain things in depth or just give you the general idea? Some patients get more anxious the more a provider talks, so it’s important to be mindful of this and get down to business. Be amicable and professional while picking up cues from their responses.
One of the last things I do is dispel any surprises. When patients get to the operating room, they’re already overcome with how cold it is, the monitors, the noises, all the people in masks, etc. I try to give them an idea of what to expect before we even roll back. It’s nice when the person who explains everything in pre-op holding is the same to carry it out in the operating room.
There’s a far deeper level of social etiquette which goes into creating an ideal patient-physician relationship, but the aforementioned are just a few of my strategies to ease the stress associated with perioperative care.