Saturday, April 9, 2011

OR chatter: Let your patient be your guide

In follow-up to a recent post about paying attention in the OR, Greg Basky posted a comment about an incident in B.C.   A patient was concerned that intraoperative hockey chatter would distract the surgeon from the operation, done under local anaesthetic.  A couple of things struck me about this story.

First, this type of chatter goes on all the time.  I usually talk with men while I'm performing their vasectomy and they often comment that it helps them relax and distracts them from what's going on.  For a routine procedure, it doesn't distract me.  If I need to focus more on the procedure, I'll stop talking.  There's only the two of us in the room, so I wouldn't be having a conversation with a third person.

But, this is utterly beside the point.  It doesn't matter that I can chat without being distracted.  What matters is how the patient feels about the conversation.

I engage in the conversation just enough to get the man talking about something he's interested in: family, work - even hockey...  It's a deliberate technique to make him more relaxed.  (I've heard people suggest that, when driving a car, you're less distracted by a conversation with a passenger than you would be by talking to someone on your cellphone, even with hands-free.  I'm not sure why, but I think it's a similar situation if the surgeon is having a conversation with the patient vs. a third party.)

However, some men prefer that we not chat, and instead want to use their own method of relaxation.   That's fine with me.

Surgeons and OR staff may scoff at the idea that they could be distracted by mere conversation.  I disagree with that, but would let that point stand in the absence of evidence to the contrary.  However, we can't ignore the effect it has on patients and their perception of care.  The case reported to the B.C. College of Physicians and Surgeons is undoubtably the tip of the iceberg.

As I mentioned in the previous post, I think that casual chatter in the OR can be relaxing during a long case.  It has its place.  But, when patients are awake during procedures, we need to be aware - to the point of hyper-sensitivity - of their needs and perceptions.  (Note to the OR staff in my room: That's the reason why, when we're operating on someone using spinal anaesthetic, you might think the cat's got my tongue.  I prefer not to chat unless it's related to the operation we're doing or about to do.  You may think I'm giving you the silent treatment because I'm upset about something.  I'm not (usually).  I guess I could have explained that to you previously.  Like 20 years ago.)

The second thing that struck me was the content of different articles on this story.  Take a look at the National Post and the Leader-Post versions.  The Leader-Post (and Calgary Herald and Vancouver Sun) versions included Registrar Heidi Oetter's comments that our behaviour in the OR should be patient-centred, whether related to conversations or choice of music.  I would be interested to know why the National Post editors chose to strike those comments in their version.  Those comments are the soul of this issue.

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