It’s a scene that plays out all too often. Your patient needs elective surgery. The surgery is authorized and scheduled with the patient; pre-op blood work is completed. But a few days before the procedure, the patient cancels. Why?
While there are many reasons, it’s a good bet that your patient may be afraid—not of the surgery itself, but of the anesthesia. Research suggests 1 in 4 people may put off surgery because of a lack of understanding and/or apprehension about anesthesia. A 2013 study reported that 81% of patients experience preoperative anxiety.
Anesthesia is safer than ever before; practitioners know that a patient has a better chance of being hit by lightning than of dying of anesthesia-related complications. But a few tips can help clinicians ease patient anxiety and help them prepare for surgery, minimizing the chances of cancellations.
1. Let your patient share worries, and offer reassurance.
Patients look to you to allay their fears. Allow time for questions and concerns, and answer them fully and candidly. Encourage your patient to bring a family member or friend to the pre-op appointment so they both can understand the anesthesia process before and after the surgery. It is especially helpful if the person who comes to the pre-op visit is the same person who accompanies the patient on the day of surgery.
If the patient is worried and the medical condition permits, encourage use of relaxation techniques like breathing exercises, meditation or muscle relaxation, or massages to address anxiety. If all else fails and if the situation warrants it (and with the approval of the physician anesthesiologist), consider prescribing a presurgical sedative.
2. Facilitate a meeting directly with the anesthesiologist if patients express concerns.
For a patient with high anxiety, it may be wise to arrange a talk with the physician anesthesiologist in advance so the patient can learn more about the anesthesia that will be administered, as well as post-op care. Many anesthesiologists are able to talk to patients in advance of the surgery or procedure.
If your patient does not meet the physician anesthesiologist in advance, explain that there will be an opportunity to ask the anesthesiologist questions prior to the surgery. This visit may take place in the hospital if the patient is already admitted, in a preoperative area on the day of surgery, or even over the phone. Your patient will have a much better experience on the day of surgery with an understanding of what will happen.
3. Persuade your patient that honesty really is the best and safest policy.
In the kindest way, tell your patient that their safety is predicated on full disclosure. While anesthesia is the safest it has ever been, encourage your patient to be forthcoming with the physician anesthesiologist about all prescription and over-the-counter medications currently being taken, such as aspirin, Ibuprofen, antacids, supplements, herbs, or vitamins. Make sure to add that many people may not think to mention that they are taking supplements (or may desire to be less than forthcoming), but it is important to bring a list of all medications.
While you will be communicating directly with your colleagues on the medical team, it is worth reminding your patients to also bring a list of medical problems, including preexisting conditions and addictions, as well as past surgeries. Ensure that both you and your patient report any complications with previous surgeries or anesthesia. With this information, the physician anesthesiologist can ensure that the patient can safely undergo the procedure. In addition, many patients find the double-reporting to be reassuring.
4. Knowledge is power (and insurance against cancellations).
Cancellations and postponements are often driven by a lack of information. Provide pre- and post-surgical instructions verbally and in writing, and instruct your office to go over these as often as necessary, with as much patience and empathy as they can muster. Encourage your patients to follow instructions regarding medications, when to stop eating and drinking, and whether a shower is required, with an antibacterial soap or a special wash, the night before and/or the morning of the surgery
5. Help your patients plan.
Out of fear or simply from lack of knowledge, some patients are unaware of potential post-surgical side effects. You can help by reminding your patient to arrange care for any dependents such as small children and make arrangements for someone to drive them home if hospital admission will not be required after the surgery. Thorough planning will enhance the likelihood that the anxious patient will not find last-minute “reasons” to cancel.
Finally, work closely with the anesthesiologist to ensure that the patient is aware of which medicines to resume and which new medications should be started. And include the designated friend or partner! The adult accompanying the patient home should be present to listen to these instructions as your patient’s recall may be poor as a result of residual effects of medications.
Dr. Jeffrey Rusheen is an Anesthesiologist at Olive View-UCLA Medical Center and a District Director of the California Society of Anesthesiologists.