Leveling up the Emotional Quotient: It’s scope in the Technocratic Oncosurgical suite

Dr. Mayank Gupta and Dr. Nimish Singh, Bathinda

The unsettling squeeze of hand and a frantic appeal to “save” her, by a lady about to undergo a hemi-mandibulectomy set an undertone of empathy and sadness in our minds. Her apprehension about who will look after her daughters if she didn’t survive the surgery, was poles apart from ours to safely negotiate an anticipated difficult airway.

Oncosurgical patients usually experience a variety of psychosocial concerns related to the kind of surgeries they undergo. Oncosurgeries often involve parting with body parts which form an integral component of a patient’s identity and their role in the society. For example, losing one half of the face, a limb, one or both breasts, the inability to speak in their original voice for the rest of their lives, or the fear of losing their life altogether. These concerns often take a backseat owing to the disease-focused tunnel vision approach adopted by the healthcare system. These concerns when unaddressed, not only lead to late presentations often in advanced stages but also contribute to anxiety, disdain, despair and prolongation of the rehabilitation process. Along with the financial cost, cancer also brings with it the additional burden of stigmatization and taboo. We as Anaesthesiologists may, at times, miss the factor of empathy in the humdrum of the technocratic environment of operation theatres. What is a routine for us is usually a life-altering turning point in someone’s lives.

In order for our care to be truly holistic and to help patients come out of their predicaments, we need to be more in touch with the humane side of our minds. As physicians, we must not limit our approach to only the pathology, disease or symptoms reported by the patients. Actively eliciting all the components of total suffering and adopting the Engel’s bio-psycho-social approach will go a long way in helping patients fare better, maintain a ray of hope in the otherwise gloomy world of cancer and to help them walk through to life beyond cancer. Leave aside other symptoms, even pain fails to be incorporated in routine pre-anaesthetic checkups (PAC) despite being declared as a vital sign more than a decade ago. Routine symptom assessment using validated tools like Edmonton Symptom Assessment Scale alongside PAC and throughout the perioperative period is a practical way forward.

Eyes speak a thousand words. Being cognizant of not only the verbal but also the non-verbal cues (facial expressions, gestures, and tone of voice) and adopting an open communication strategy rather than the age-old closed questions (Do you have cough?) during PAC will help  patients to bring forth their psychosocial and spiritual concerns. This will in turn go a long way in helping anesthesiologists to develop a sound therapeutic relationship with their patients which is traditionally denied owing to their technocratic training and practice.

About the Authors

Dr. Mayank Gupta is an Associate Professor at the Department of Anaesthesiology and Critical Care at AIIMS, Bathinda.

Dr. Nimish Singh is a Senior Resident at the Department of Anaesthesiology and Critical Care at AIIMS, Bathinda.

Leave a comment