The Empathy Surgeons Often Forget at the Bedside
For patients and families, the need for urgent surgery — such as after a new cancer diagnosis or an unexpected postoperative complication like a perforated ulcer — often comes as a shock. Rather than delivering the news abruptly, clinicians should begin with a preparatory statement such as 'I have serious news' or 'Things have changed,' recommended Lauren J. Taylor, MD, and colleagues in a recent JAMA article.
Addressing Emotions First
The new information should then be presented clearly, under a simple heading — for example, 'You have a hole in your intestines. We usually treat this with surgery and several days in the hospital.' The authors advised against overwhelming patients and families with long technical explanations or exhaustive lists of potential complications, which often dominate informed consent discussions.
This kind of news frequently provokes intense emotional responses, including fear, grief, or anger. In such moments, physicians should prioritize empathy over clinical detail. Simple acknowledgments like 'It must be hard to see your dad this sick' or 'I wish I had better news' can provide far more comfort than factual explanations alone.
Scenario Planning Over Statistics
In high-stress situations, many patients struggle to understand the likely course of illness. Even when complications and prognosis are clearly explained, patients often underestimate the risks or overestimate their chances of survival — especially in life-threatening conditions. In these cases, numerical statistics may fail as effective communication tools.
Instead, Taylor and colleagues advocate for 'scenario planning,' a method adapted from business strategy. This approach involves presenting a spectrum of plausible outcomes: 'In the best-case scenario, we hope she'll recover after a short hospital stay and return home,' followed by, 'In the worst-case scenario, I'm concerned about serious complications or even that she may not survive this illness.'
Stating Goals and Limitations of Surgery
Consent conversations often focus heavily on surgical technique and potential complications, which can divert attention from what patients truly need to understand. There is also a risk of oversimplifying the procedure with phrases like 'We'll fix this,' which may create false reassurance.
A more effective approach is to clearly articulate the goals of surgery — such as prolonging life, relieving symptoms, preserving function, or enabling a diagnosis — and to explain what the surgery cannot achieve. While technical risks like bleeding or infection are usually addressed, broader consequences, including pain, prolonged recovery, and the potential loss of independence, are often underdiscussed.
It is also important to recognize that the patient's goals may differ from those of the surgical team. This is particularly relevant in cases such as cancer surgery, where a technically successful operation may not align with a patient's preferences — especially if extending life at all costs is not the patient's priority.
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