SSSFELICIANO’S MAR [15-02]: Proper Operating Etiquette: Maintaining a Tactful Attitude while Operating

MEDICAL ANECDOTAL REPORT
Indexing Title: SSSFELICIANO’S MAR [15-02]
MAR Title: Proper Operating Etiquette: Maintaining a Tactful Attitude while Operating
Date of Medical Observation:  March 2014
Tag: Every surgeon should be tactful even when operating to avoid patient complications
Category: Professional/Ethical-Stimulus
NARRATION:
We admitted a 54-year-old male with a Warthin’s tumor on his left parotid. The patient was scheduled for superficial parotidectomy. His diagnosis, plan of management, complications of the contemplated procedure were well explained to the patient and he consented to the procedure. Came the day of his operation, I was one of the assist in the operation which was done by our senior, assisted by our consultant for the case. The patient was under general anesthesia and the operation was started. While our senior was dissecting the mass, there were times when he accidentally uttered “Oops” whenever there was a vessel that has been nicked, or he was out of the plane of dissection. Our consultant then commented that we should refrain from uttering words which may cause anxiety for the patient. He reiterated that uttering words like “Ooops” may give an impression to the patient that the operation is not going smoothly, that operative findings are not favorable or worse, something dangerous was going on in the operation.
The anesthesiologist smiled at us reminding us that it was a good thing that our patient was asleep as he was under general anesthesia. We just kept silent as our consultant sincerely taught us that one of the ethics of operating is placing patient safety first. What if the patient was awake and upon hearing unfavorable comments, he could have been anxious during the operation causing complications? What if we were the one operated and we could not see what’s going on? From then on, we tried our best to be watchful of what we are saying while operating. The operation went smoothly and the patient was discharged without complications.
INSIGHT:
(Physical, Psychosocial, Professional/Ethical)
(Discovery, Stimulus, Reinforcement)
Being a physician is one, being a good one is another, and by being good, a physician does not only require one to be theoretically equipped, compassion-filled, and finely skilled but also to be trained to be tactful in dealing with patients, relatives and colleagues. Being tactful means being discriminative of what he thinks, do and say.
In our everyday lives, we deal with patients and it is not enough that we deal with them tactfully only when we are explaining to them their disease and our plan for them. When we operate on patients, they are usually asleep, and if not, they are in a state of sedation. However, this does not mean that we are free to say whatever we want. We should still be careful in uttering words as this may affect the way our patients think, as well as our colleagues.
In this case, I was reminded that increasing the level of anxiety of patients unintentionally could have a bad impact to our patients. Also, our colleagues, as in this case, the anesthesiologists that we are working with are affected. Whatever we say will affect the operation, so better be wary.  Moreover, this has stimulated me to share this simple lesson that our consultant imparted to us. We are lucky that we as we do our operations, we are guided physically and ethically. Again, another etiquette in operating was given importance to, and it is by being tactful in dealing with our patients during operations.
 
ROJoson’s Notes (16dec30):

There are a lot of “operating (room) etiquette” to observe by surgeons.  These can consist of etiquette in relations to operating room staff or colleagues and to patients as well.
For patients, the operating (room) etiquette consist of those related to patient respect, patient safety, and patient psychosocial care.
What is illustrated in this Medical Anecdotal Report is the etiquette in patient psychosocial care.   The surgeon must not do or say something that will create anxiety of the patients, even unintentionally.   The incident given here is “uttering words like “Ooops” may give an impression to the patient that the operation is not going smoothly, that operative findings are not favorable or worse, something dangerous was going on in the operation.”  This should be done by the surgeon. 
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