On my face; in my face

Operations on your face are very much in your face. It is an oddly intimate atmosphere where strangers are very close  to you, murmuring in your ear advising you to close your eyes. The knife makes no noise – nothing like the whine of the dentist with their noisy drills and sucking tubes. Background music has no place in the austere day surgery room, although in one of these bizarre and impromptu occurrences that humanises the NHS,  the receptionist’s daughter turned up to give us a turn on her cello.

New Discourse Needed

This atmosphere is a total contrast to the formalities and generalities of the usual dialogue with the patient. The abstractions and generalities of a rights-based approach – duties, principles, respect – are linked in the time before the operation to the risk-based vocabulary constructed to serve the institutional interest and provide evidence of due process. These are essentially formal and impersonal communications. Clinical staff administer them and patients sign them.

The conversation takes a wholly different turn in the theatre. A whole new discourse is needed – one that acknowledges that the patient is awake and listening. Imagine if instead of the set-piece announcements you get from the pilot you heard the entire cockpit conversation for the whole flight.

Suggestions Please -new script needed

My first suggestions for that much needed guidance for authentic yet reassuring dialogue are below – suggestions welcome to create that warm, reassuring and calming ambiance that optimises clinical outcomes.

  • I liked hearing the consultant sharing learning with the registrar – what would they do? what were the options?Where are we now? what are the risks? (could be dodgy but not when done as part of an established professional dialogue). It is essential that the registrar plays his/her part reinforcing the professional context by knowing most of the answers or least sounding eager to learn.
  • Keep it up – by this I mean that if clinicians start by  involving the patient in the conversation then they must keep it going. There is a strong temptation as the op goes on, to get absorbed by the procedure – a tricky slice here, a dab there. Silence apart from heavy breathing and random tugging can be disconcerting. Operations on the face bring strangers close enough for kissing.
  • Discussions about rotas, lunchbreaks and last night’s or indeed tomorrow’s piss-up are to be discouraged. They break the mood
  • Any surprises – bloody hell we have a bleeder here – or discussion about the non-availability of some piece of kit should be kept to a minimum. While they can act as a reminder that we are all human, they do again break the mood
  • Jokes must include the patient and not sound as though the patient is the joke.
  • A note for us as patients is in order – do not guess at who these people are. I mistook a registrar for a houseman. Fortunately they took it well since they were doing an intensive bit of needle work on my nose at the time
  • We need some sort of concordat on what I would call ‘minimising’ vocab – as in ‘a wee bit of bruising’, ‘a little discomfort’ (as in ‘excuse me while I stick a needle in your face’)

Tell us what you would like to hear – we need this now and more and more in the future with the growth of day surgery.


  1. Andrew Craig says

    Not sure what I’d like to hear after an experience like that, but there’s one thing I wouldn’t like to overhear from the clinicians – with apologies to Norma Desmond: “He’s ready for his close ups now, Mr DeMille”. Hope it hasn’t put paid to your modelling career.

  2. says

    Took away the King’s questionnaire asking how satisfied I had been with the information and support received.Excellent idea and I can see that these are important aspects of the care but to understand the results, we need to know the general outcome of the treatment received. People who are satisfied with the main event – did the treatment cure me? – will be largely satisfied Those who had a rough time or feel that the outcome was not up to their expectations will give a different view that will not be about the quality of the information but the perceived quality of outcome. There is a question about bad news and how this was ‘broken to you’. This will give a clue to a respondent’s frame of mind and users of the data should realise that a poor outcome here will skew the rest of the responses. Run the data twice with that question and without.

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