Pre-operative talk is the surgeon in the implementation of surgical operations before the patient and family members or related people, units in charge of talking about the patient’s condition, the medical measures to be implemented, medical risks and prognosis, etc., objectively informed them, and to answer their relevant inquiries, questions, in order to get the understanding and understanding of the patient and family members, to reach a unified opinion on the upcoming surgical treatment.
With the progress of society, law and science, how to better conduct the pre-surgical conversation has become a topic that every surgeon must study. Because of today’s medical model, the surgeon is not only facing the biomedical disease, but the biomedical patient of today’s modern society. Simply put, the surgeon is not only treating the disease, but the disease and the person. That is, people have social nature, which objectively forms, when conducting preoperative talk, not a simple contact with the sick body, but a contact with a social group. Therefore, in order to achieve the purpose of preoperative conversation, it is necessary not only to master the appropriate method, but also, and more importantly, to master certain conversation skills and art, which is as important as the level of surgery, and is also a scientific issue. For this reason, an excellent surgeon should not only be able to do surgery, but also be good at expressing, thinking and summarizing.
So, how to master the skill and art of preoperative conversation? What is the purpose of our preoperative conversation? As a simple example, some people may think that the preoperative talk may be inappropriate in wording. For example, if a good friend who has not seen each other for many years gets together, he is very excited and raises a glass and drinks it all without saying anything, but at this time, he has expressed the feelings of reunion after a long time. Therefore, to master the skills and art of conversation, can not simply understand just say with the mouth, in fact, we in the usual medical process of the patient’s words and actions are observing and feeling. I think to really master the skills and art of preoperative conversation, first of all, we must use the physical language of our surgeons, which requires us to remember the teachings of Wu Jieping: “all for the patient, for all patients, for the patient all”, followed by a comprehensive knowledge of the discipline and the latest developments, but also to understand We should also understand the differences in the knowledge and cultural background of different patients and their families.
The preoperative conversation must firstly inform the patient and his or her main legally responsible relatives or the person in charge of the unit in advance, and agree on a clear time and place for the conversation. Secondly, the surgeon who conducts the preoperative interview must be the attending surgeon who is very familiar with the patient’s condition, and the head of the department or hospital is required to participate in critical patients or major and complex operations.
The content of the preoperative talk generally includes the diagnosis of the patient’s disease, the necessity of surgical treatment, the basis of surgical modality selection, the possible adverse reactions, complications and accidents during and after surgery, the effective measures to be taken to prevent intraoperative and postoperative complications and accidents, the prognosis of surgical treatment and financial estimation, etc.
The purpose of the preoperative talk is to let the patient and his family understand: 1) the collective team spirit and role of surgical treatment; 2) the trust of the patient and his family in our medical service and medical level; 3) the feeling of the patient that he has enjoyed the most scientific and reasonable diagnosis and treatment of the disease; 4) the necessity and risk of surgical treatment; 5) the elimination of the fear of surgical risks; and 6) the understanding of our risk prevention measures. The surgeon must be able to understand the measures and ability to resist risks and the limited ability to resist risks. 6. the possibility of comprehensive and continuous treatment. 7. the late performance and unpredictability of surgical treatment results.
There are some adverse psychological conditions that the surgeon must overcome and eliminate prior to the pre-surgical conversation. These adverse psychological conditions often have the following manifestations: 1, in order to train surgery and surgery; common in some young, immature surgeons, often eager for success, lack of love for patients, poor grasp of surgical indications. Preventive measures are to adhere to a strict three-tier room inspection system. 2, in order to simply improve economic efficiency, blindly expand the scope of surgery; common in some medium and small hospitals, comprehensive medical level is insufficient, reluctantly carry out some critical patients, complex surgical procedures. Preventive measures to strengthen the hospital hierarchy and hospital management level; 3, individual heroism, ignoring the surgical team spirit; common in surgeons who have the psychology of unfair competition, manifested in highlighting the role of the individual, ignoring the role of others, often imperfect preoperative preparation, intraoperative, postoperative ability to deal with emergency problems. Surgeons must have team spirit. Only by overcoming these undesirable psychological conditions can they not tell big lies and lies when talking to patients and their families before surgery, otherwise they will be consciously or unconsciously in deceiving patients and violating the professional ethics of doctors.
Here we will talk about the following aspects specifically in clinical work, some experience when talking with patients and their families preoperatively.
1. the collective team spirit and role of surgical treatment.
Since his admission, he has been under the care of our medical staff from the beginning to the end. In clinical work, we often encounter such a problem, the patient is Professor Wang in the outpatient clinic received ward hospitalization, specific management of his hospitalization and attending doctor, of course, not Professor Wang, in fact, we have a medical collective for each inpatient surgery, however, some patients may only think that Professor Wang to his medical treatment, if Professor Wang is not a daily check, part of the patient even think how no one cares about him. Therefore, preoperative talk must emphasize to patients and their families the collective team spirit and role of surgical treatment, do not overemphasize the role of a particular doctor, otherwise it will cause misunderstanding of the patient, but also not conducive to the unity of the surgical treatment collective. Often patients and their families will chase after a particular doctor and ask: “Dr. Wang, are you the one who operated on me? , I’ll trust and ask you to operate on me.” As long as there is a team spirit, you will naturally know how to answer most reasonably.
2. Win the trust of patients and their families in our medical services and medical level.
Patients and their families often have such a state of mind when they agree to talk and sign with the surgeon before surgery, that is, they want to fully understand through this conversation whether the patient’s condition is clearly diagnosed by the surgeon since admission, and how certain the surgical treatment will be successful here. What is the level of postoperative care? Therefore, during the interview, they may ask what is the patient’s disease? How advanced is the disease? Have your doctors encountered similar cases before? Have you performed a similar procedure before? Of course, some patients have some knowledge through other means, but it may not be comprehensive. During the conversation, the surgeon must use easy-to-understand language, sincerely and objectively tell us the main diagnostic process and diagnostic results of the patient, can not be sure, the need for surgical investigation, post-operative pathology to confirm the diagnosis of the case, so the focus of the disease on the degree of damage to the body, the program of investigation, and why to explore? We should fully introduce to them our own past experience in diagnosing and treating the disease, with examples, and fully introduce the ability and confidence of the doctors and nurses who participate in the treatment team, with the aim of making them feel that we are serious and responsible for the patient’s condition, accurate in diagnosis, confident and well-prepared before surgery. Let patients and their families feel that our medical services and medical level have characteristics and level. Only in this way will they “have a good chance of success in surgery here. Otherwise, even if the diagnosis is clear, some patients still go to other hospitals for surgery.
3. The patient feels that he has enjoyed the best time and the most scientific and reasonable diagnosis and treatment of the disease.
Patients and their families have a clear diagnosis of their disease and the purpose of treatment, but also have the psychological, that is, can not take surgical treatment, must be immediately operated? The actual fact is that there are many ways to take surgery, which is a good way to take surgery? For example, in the treatment of BPH, there are many ways to treat it, and it is sometimes difficult to determine when surgery is needed and what surgical treatment to take. Our surgeons have decided the best time and method of surgery according to the patient’s condition and the surgical technique, but it is not easy to make the patient and his family understand and accept it through conversation. Therefore, we surgeons should explain the advantages and disadvantages of each treatment method to them in easy-to-understand language, and help patients to choose scientifically. In this process, surgeons must be realistic and avoid inducing patients to accept a certain surgical method based on their own interest. How to get patients to accept the surgeon’s surgical plan and truly demonstrate informed consent and choice requires skill. This requires skill. For example, there are many surgical options for prostate surgery, including suprapubic transcystic prostatectomy, retropubic prostatectomy, transcervical or urethral prostatectomy, etc., which should be presented to the patient one by one. As to which surgical option to choose is like when you go from Dongdan to Tiananmen Square in Beijing, there are many roads, all of which can be reached, but ultimately there is a best and fastest road. It is clearly indicated that the surgical option we choose is that best road. A more emotional way is to say to the patient that if you were me or my father or mother, I would make the same choice. This way the patient will feel that you are communicating with him heart to heart, treating him like a family member and caring for him. The patient and his family will feel a sense of security and confidence, which means that they will easily accept the proposed surgical plan and will understand and not worry about the possible complications of the surgery to be discussed.
4. The necessity and risk of surgical treatment.
As in the case of the patient mentioned earlier, from the medical point of view, surgery is necessary. Why do we have to emphasize it here? Because there are some diseases that require surgical treatment from the disease itself, because we are treating the patient, so when we consider the treatment plan, we also consider the person’s age, general condition, family and socioeconomic status. For example, a patient with prostatic hyperplasia in his 90s who has urinary retention, azotemia, diabetes, and coronary artery disease. The disease itself requires prostate surgery, but the patient’s age and general condition do not allow for surgical treatment, and he can only undergo simple catheterization or cystostomy. This means that the risk of surgery is higher than the need for it. There are times when the need for surgery is greater than the risk. For example, a young man with a small volume of renal cancer is found on physical examination, but the patient has no symptoms. Many patients and their families do not always understand the relationship between the necessity and risk of surgery, and even misunderstand it.
5. Eliminate the fear of surgical risks, understand our measures and ability to resist risks, and the limited ability to resist risks.
In general, patients and their families have two psychological conditions when they talk and sign before surgery: one is very afraid of the riskiness of surgery; the other is that this is a routine procedure in the hospital, or even that the surgeon is scaring the patient, shirking responsibility and accepting passively. For the former we must repeatedly emphasize the necessity of surgery and the need to be risky for this reason. Before talking about it, you can give some well-known examples, such as walking in the street, there is the danger of being hit by a car or by a bicycle, there is the danger of tripping over a stone, do you not go out and walk. Even if you stay at home, there is still the danger of earthquakes. Surgical complications are like walking and falling, they are not terrible, but we can’t ignore them, we don’t want them as doctors, and we don’t want them as patients even more. So we have to cooperate and trust each other to avoid them, and for each risk we can eliminate their fear by the probability of occurrence in the past and the measures and abilities we have to resist the risk, and enhance the confidence of patients to overcome the disease. Otherwise some patients are even frightened and give up the chance of surgical treatment. For the latter the surgeon should especially emphasize before the conversation that talking and signing is not meant to shirk responsibility, but to respect the patient’s right to informed consent and the patient’s right to choose the surgical treatment. The focus should be on talking about the limited ability to resist some surgical risks from the current level of medicine available. Let them have a psychological preparation or whether they can accept some complications and unexpected situations that may occur in the surgery, and hope to get the patients’ understanding and consent to the surgery. For example, surgery on isolated kidney renal cancer is likely to result in failure to preserve the kidney or postoperative uremic syndrome, which is sometimes difficult to avoid.
6. The possibility of comprehensive and continuous treatment.
As patients and their families, they always hope that one surgery can be done once and for all, however, due to the different developmental patterns and biological characteristics of different diseases, it is decided that surgical treatment is not a one-size-fits-all method. For example, kidney transplantation is only a part of kidney transplantation, which requires insisting on long-term application of anti-rejection drugs after surgery, which is expensive on the one hand and has toxic side effects of drugs on the other; tumor patients also need to apply chemotherapy and radiotherapy after surgery; urethral clubbing requires regular urethral dilation after surgery, etc. Just like a person who just eats meat and no vegetarian food everyday does not work. During the preoperative conversation, patients and their families should be made aware of the necessity and possibility of comprehensive and continuous postoperative treatment. Show that surgical treatment is only a part of the treatment of this disease so that the patient can be more fully prepared psychologically and actively cooperate with further treatment.
7. Late performance and unpredictability of the effect of surgical treatment.
The effect of surgical treatment is the prognosis of the disease and is the ultimate concern of the patient. The prognosis of patients is directly affected by the effectiveness of surgery. In most surgical diseases, the efficacy of surgical treatment is obvious and immediate. Therefore, most patients and their families, with the psychology of eagerness to achieve results, or even a momentary failure to see the immediate effect, complaining that the operation was done in vain or unsuccessful, causing unnecessary medical disputes. Some surgeons may have a bad psychological state before surgery and over-exaggerate the role of surgery, causing great disappointment to patients. Due to the characteristics of different diseases, individual differences and the progressive course of the disease on the effect of surgical treatment performance of late and unpredictable phenomenon, such as Cushing’s syndrome, after removal of adenoma, obesity is not recently disappeared; kidney stone surgery and bladder cancer surgery after the recurrence of the phenomenon, often unpredictable. Therefore, during the preoperative talk, patients and their families must be informed in advance of the late expressiveness and unpredictability of the effect of surgical treatment for some diseases; patients are most concerned about their prognosis, and surgeons must not ignore the prognostic study of their patients.
Preoperative conversation may seem to be a small problem, but he contains a deep chagrin of philosophy. It reflects a surgeon’s medical skills, medical ethics and responsibility, and has a very important role in improving the doctor-patient relationship and reducing medical disputes. Surgeons in the clinical work must continue to improve the method of preoperative conversation, improve their conversation skills and art.