Chapter 8 Talking With Patients During Surgery Saves Time

10.1055/b-0037-142179

Donald H. Lalonde, Duncan McGrouther

During the years when we performed hand surgery with sedation, there was no point in educating patients during the surgery. They would not remember what we told them because of amnestic medications. With each passing year of wide awake hand surgery, it is becoming more and more apparent that patient education during surgery is very helpful in many ways. You can educate your patients about postoperative care and how to avoid complications while you are operating, and this is a better use of your time than chatting with the nurses about the weather.
The time you spend talking to patients during the surgery is time you do not need to spend with them in the office before or after the surgery.
Investing time to educate the patient during the surgery will save the time that would be lost on complications that occurred because the patient did not know how to look after his or hand postoperatively. Educated patients understand the importance of their rehabilitation protocols, are more likely to be compliant with postoperative instructions, and may require fewer follow-up appointments.
You often find out important details about the patient′s life and activities that you did not learn about in the initial consultation.

Patients love personal education in a nonrushed fashion from their surgeon. They are able to develop a one-on-one bond with you that was not possible in the days when sedation meant they had no memory of the procedure, and they did not feel that they were an active participant in the process.

Patients know exactly what their hand should look like. If you have reduced a crooked finger, they can tell you if you have it right before you leave the operating room.
Talking with patients during flexor tendon repair about how to look after their hand after surgery can decrease your rupture and tenolysis rates (see Chapter 32).
Talking with patients during finger fracture repair about how to look after their hand after surgery can decrease your stiff finger rate.
In Clip 8-3 advice is given to a patient, while the finger fracture is K-wired, about how to look after the finger in the days after surgery. Chapter 41 has a clip of this patient′s whole care, including advice about early protected movement. Chapter 41 also has a clip on intraoperative advice for finger fracture patients.
With complicated procedures such as a flexor tendon repair or a K-wired finger fracture, patients leave the operating room with a full understanding of how to take good care of their hand after surgery to get a better result. They understand that if they move the hand too much, the repair will fall apart. If they do not move it at all, everything will become stuck.
A 10-year-old is given advice in Clip 8-4 during flexor tendon repair about how to look after the finger in the days after surgery. Chapter 9 has a clip of this patient′s whole care.
For a clip of a surgeon and therapist explaining the Saint John postoperative flexor tendon repair protocol to a patient during surgery, see Chapter 15.

Never say something like “Oops.” Create an atmosphere of calm, efficiency, and competence.
A silent surgeon can seem quite foreboding, while one who speaks too much without listening can also fail to reassure. The modern version of the “bedside manner” is the “operating table side manner.”
Do not ask the scrub nurse for a blade, scalpel, or skin hook. Use terms like “a number 15” and “single hook.”
Do not pass bloody swabs or instruments in front of the patient if you can avoid it.