Going under the knife, with eyes and ears wide open

More surgery is being performed with the patient awake and looking on, for both financial and medical reasons. But as surgical patients are electing to keep their eyes wide open, doctor-patient protocol has not kept pace with the new practice. Patients can become unnerved by a seemingly ominous silence, or put off by what passes for office humor. Doctors are only beginning to realize that when a patient is alert, it is just not O.K. to say: “Oops!” or “I wasn’t expecting that,” or even “Oh, my God, what are you doing?!”

In a continuing study of negative experiences during awake procedures, a patient informed University of Chicago researchers, “The surgeon told me he was going to get a sharper knife, and started laughing.”

As a heads-up to staff members, some hospitals now post warning signs on the O.R. door: PATIENT AWAKE.

“For a thousand years, we talked about the operating theater,” said Dr. Mark Siegler, a medical ethicist at the University of Chicago and an author of a recent study on surgeon-patient communication during awake procedures, published in the American Journal of Surgery. “And for the first time, in recent years the patient has joined the cast.”