During ‘awake’ procedures, surgeons must choose their words wisely

“Awake” surgeries change the way surgeons interact with other members of their teams, and create communication problems between them and the patient, according to a new study.

Procedures using local anesthesia are becoming more common, but according to a survey of surgeons published in the American Journal of Surgery, many aren’t trained on best practices for communicating with nervous patients. The team interviewed 23 surgeons at two hospitals, according to the study, and all had to develop their own strategies for handling “awake” surgeries.

“The surgeons that we interviewed told us that having an ‘awake’ patient changed the way they communicated with their team,” Alexander Langerman, M.D., an assistant professor of otolaryngology at Vanderbilt University Medical Center and a senior author of the study, told Reuters. “None had formal training in surgeon-patient communication during awake procedures."

Because “awake” surgeries are often more efficient and satisfying for patients, surgeons have adapted to “awake” surgeries in a number of ways, according to the study. Many developed code words to communicate potential errors to the rest of the team, according to the study, instead of an “oops” that might scare the patient. The physicians had to learn to choose their words carefully when dealing with pain management or letting patients know that they may experience different sensations during the procedure.

Some patients were also offered sedatives instead of general anesthetic, according to the study, as those medications would relax or help patients fall asleep during the procedure. An operating room can be overwhelming for a patient, the surveyed surgeons said, so some played music or kept the number of people moving in and out of the OR to a minimum.

One concern the surgeons had, according to the study, was the impact of the “awake” surgeries on surgical trainees. Patients were nervous about having trainees practice on them, the surgeons said, but such students need hands-on training to progress in their studies. Most of the interviewed surgeons said they had to limit the involvement of trainees.

- here’s the study abstract
- read the Reuters article