Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Defusing Patients’ Emotional Stress


I believe it's my first responsibility to recognize my patients' emotional stress and start to defuse it. I do this by framing the ongoing issue in a way that is understandable to the patient and their family.

As a vascular and endovascular surgeon, patients under my care may be afflicted with conditions that are of direct threat to their limbs, their functionality, and their life.


Within this context, my first responsibility is to recognize their emotional stress and start to defuse it. I do this by framing the ongoing issue in a way that is understandable to the patient and their family, providing real estimates of the ongoing threats, and the methods by which the problem can be addressed, mixed with levity where appropriate. As a means to this end, I must speak with all involved, judging their capacity for information and cultural leanings.


I find my greatest joy in counseling a patient is when I actually bring them to a coherent understanding of why a particular condition doesn’t need an operation or intervention. As I bid goodbye to the patient and hear over my shoulder, “that’s great news,” I know I have started a doctor-patient relationship that is going to be durable, enjoyable, and informative.


At an operation, I treasure the inherent trust the patients and their families place in my hands. Undergoing surgery is a tremendous submission to my abilities and to those of my teammates. I have appreciated patients come to this point in many ways – some through mathematical discussion of procedural risks, and others by asking me to share a prayer together.


Ultimately, I am inspired by the courage of my patients to come to surgery, and thus I seek to ensure that the very best happens to them in the operating room. I have had the fortunate experience to learn technique from some of the best aortic surgeons in the world, and my role to deliver operative care is built on communication and anticipation.


While hemorrhage and end-organ ischemia may be measured episodes in most of my operations, I have found communication of these critical next steps of an operation to nursing, perfusion, and anesthesia colleagues can greatly allay the emotional and physical stress professionals can experience in the operating room.


A team that is relaxed and in tune with the pace of the operation is my goal—when this occurs, I know that we can deliver the best for the patient, even when we have to grasp an operative challenge that resides at the very ends of our reach.


One of the unique facets of a career in vascular surgery is that many patients see me on a regular basis for many years, if not decades, for monitoring of their asymptomatic vascular pathologies. Such visits allow me to sharpen non-operative skills to the end of cardiovascular risk reduction.


For example, patients with aortic dissection may be followed for years before the dissection requires intervention. The mention of aortic dissection, or a patient Googling the term, will lead to reciting mortality rates referable to the acute phase, and cause immediate distress. I see my role in this phase of care to identify the issues and explain to patients how to live with their conditions and not have it confine them.  Similarly, those recuperating from major operations can be greatly eased by showing them ways to live through their recovery.


As time passes, I see the process of aging affecting my patients, and they may comment they see the same in myself, but we learn from each other how to live well from our friendship as a doctor and patient built over our time.