The Top Ten Things You Should Never Say During Surgery
10. “Don't worry. I think it is sharp enough.”
9. “Nurse, did this patient sign the organs donation card?”
8. “Damn! Page eighty-four of the manual is missing!”
7. “Everybody stand back! I lost a contact lens!”
6. “Hand me that...uh...that uh.....thingie.”
5. “Better save that. We'll need it for the autopsy.”
4. “What do you mean ’You want a divorce?’”
3. “Whoa, wait a minute, if this is his spleen, then what's that?”
2. "Ya know, there's big money in kidneys. Hell, he's got two of 'em.”
1. "Accept this sacrifice, O Great Lord of Darkness."
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There are countless ways you can make the patient experience better by using language that neither scares nor confuses. Many words should be stricken from office jargon or substituted with euphemisms. The more innocuous the terms used, the better the patient will feel about the procedure. Each practitioner needs a personal list of taboo words and field-specific terminology.
There are good and bad ways to give patients information. In general, avoid technical terms. While these terms make the doctor appear learned, they are often confusing to the patient suddenly required to learn a new vocabulary in order to understand a complicated procedure. Technical terms often sound sterile and may frighten patients who have visions of dreaded procedures being performed on them or loved ones. Patients appreciate plain English.
I was enjoying lunch at the local deli when the owner, who liked to hang out with the doctors, told us a story. He had a surgical procedure under local anesthesia. It was a common procedure I do in my office. He told us how, during the operation, the surgeon told him he was “grinding the bone” and he nearly passed out. I was a young doctor at the time and I remember his words to this day. At that moment, I realized there are good and bad ways to give patients information. If you get it right, your clear and simple explanations are just another manifestation of great bedside manner.
Whenever I do that particular surgery and get to the part where I need to use the drill to remove some bone, I tell the patient, “I’m smoothing off your tooth. Don’t let the sound of the drill bother you.”
Smooth is better than grind, and tooth is better than bone. That’s the right way to say it, even if it’s not entirely true. By utilizing proper words and explanations, the patient has a pleasant experience.
Some patients like to know what’s going on and all patients like to know when you will be finished with the procedure. You have to decide which type of patient you have. If the patient says, “Doc, do what you have to do, just don’t tell me about it.” They really mean it, and you should limit your talk to things unrelated to the procedure except for keeping them abreast of how much longer you have to go.
Since everyone wants to get out as soon as possible, try to be fairly honest in your time to completion appraisal. Use words of encouragement often and link your patient’s good behavior with being able to get finished faster. This type of praise gets the patient to work harder to help you get done quicker: “You are doing great and by being such a great patient you’re helping me to get done faster.” When you are on the last stage mention that too: “You are doing fine and we’re on the last stage.” Compliments make the patient feel good about themselves, they distract them from thinking about the procedure, and they keep them focused on the positive rather than imagining everything is going wrong.
In contrast to the patient who doesn’t want to know anything, some patients like you to describe every detail of the procedure. For the inquisitive patient, you may tell them what you are doing but try not to be too graphic. You can still use innocuous terms like smoothing instead of drilling and tooth instead of bone.
Other patients want any type of conversation to get their mind off the procedure. To accomplish this goal, you may speak of simple matters like discussing an upcoming holiday, the weather, a recent or planned vacation, as well as throwing in a multitude of compliments for how well they are doing.
If you can’t chew gum and walk, don’t start talking to your patient while doing a procedure requiring your fullest attention. You should, however, explain to the patient why you may not be talking throughout the procedure, and that you’ll try to keep them abreast of what’s happening. “Some of this procedure requires that I concentrate, so I may not be able to talk too much while I’m working.”
If you are going to tell the patient what you are doing, discretion is still warranted. You don’t need an inquisitive patient fainting on you. Use simple lay terms like, “I’m removing the infection.” That sounds much better than, “I’m scooping out the dead bone from your arm.”
It is easy to forget what terms are technical when you use them on a daily basis. The word tissue may seem reasonable to use with patients, but for many they picture Kleenex when you use that word. Try skin or gum and they’ll know what you mean.
“I’m making an opening to remove the infection,” sounds much better than, “I’m cutting you open to remove the infection,” or, “I’m making an incision,” which sounds sterile, technical, and invasive.
Remove sounds better than extracting, or pulling. And for heaven’s sake, they will have no idea what you’re doing if you tell them you’re enucleating the cyst or debriding the lesion.
Don’t tell a patient they have to go under the knife. That term is grotesque and archaic. It should be banned from medical jargon. A knife has connotations of cutting and stabbing. It is much kinder to say, “You need an operation (or surgery),” or “We have to remove that little lump.”
Never mention that you are working on muscles or bone. “I’m putting you back together,” is much better than, “I’m reconnecting the muscles.”
Words and phrases that confuse or scare the patient and some substitutes follow:
Irrigate/debride the wound = rinse the cut, or rinse out the opening.
Necrotic = bad stuff – “I’m going to remove the necrotic tissue,” versus, “I’m going to remove the bad stuff.” Yes, you went to medical school for all those years to talk like an idiot. You can use the term infection, as that is a common term and to remove infection sounds good to the patient.
Sutures are stitches. Tissues are either gum or skin.
Don’t tell your assistant you need her to stop the bleeding; rather you need her to control the flow. The patient has no idea what is flowing and bleeding makes them think there is a problem. Telling your assistant to irrigate or suction is another cryptic way of telling them to suction excessive bleeding.
Orthopedic and oral surgeons use an instrument called a bone cutter. “Mary, pass the bone cutter,” is not what most patients want to hear. Doctors with great bedside manner don’t own bone cutters. They use trimmers; not bone trimmers, just plain old trimmers.
Some doctors use chisels during bone surgery. Most people would rather go to the doctor who uses smoothers or files rather than chisels. We don’t use mallets or hammers, we use tappers. While you may use clamps I use clips. Pliers and forcepsare grippers, and a saw can be a linear file. Make up whatever terms you must to convey a friendly environment.
Your patients shouldn’t have an atypical infection (lesion, anatomy, etc.). They’d better understand and much rather have an unusual infection, or an unusual shaped tooth.
“Exacerbations” are “flare-ups.” “Protracted” is “longstanding.” “Occult” is “hard to find or hidden.” Never discuss the “prognosis” with your patients. Instead, you discuss “the chance of this working out.” You never “lay a flap,” you “lift the gum back.” Your patients appreciate plain English.
Pain is discomfort, soreness, or an ache, but don’t avoid mentioning pain if there is a good chance the patient will experience some. You patients will worry more if you tell them there could be some discomfort and they have pain. It is actually better to have them expect the worst and be pleasantly surprised. You will never have a patient call you after hours worried that they had no pain after you told them they could have some.
Today, most patients know the term scalpel. Your patients should never hear that word from you. Say, “Pass the Bard-Parker fifteen,” or your assistant can say, “Would you like the B-P fifteen?” This is merely a code for the brand and type scalpel. The patient should have no idea when or where you use a knife.
These are just a few ideas you can incorporate into your practice to make the patient experience better. Buy a small digital recorder and keep it available to record your next ten conversations with patients to see how well you communicate and the quality of your bedside manner. Keep your ears open and have your staff alert you to any terms they think need to be changed to make your practice the one everyone wants to go to for care.