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Young GI Angle: How to anticipate patients' questions and anxiety for planned major GI surgery

Effective and empathic communication with patients is an important skill that surgeons in training need to master, before regarding themselves as ‘‘consultants’’. This is particularly true in colorectal surgery. Surgery for colorectal conditions might involve complex procedures, and could require formation of a stoma – sometimes more than one. Anxiety ahead of surgery can be therefore anticipated in most patients, and it is justified. Several studies on patients who needed major GI surgery, suggested that anxiety (as measured by validated tools) tends to be higher early after elective procedures, but it takes several weeks to get back to normal. Irrespective of the mean by which the level of anxiety is measured, I would suggest that – should these findings apply to our patients – we are losing an opportunity to make the perioperative experience less stressful, at least in those patients for whom surgery can be planned. Certainly, it is not possible to reply in a reassuring and exhaustive way to the questions of the patients, without adequate knowledge of the condition, as well as of the surgical techniques and phases of the procedure. Young surgeons would struggle to sustain a discussion with patients and their families if not adequately trained, and patients would feel disoriented. Anticipating questions requires experience and a specific training. Just as learning surgery requires a structured and gradual path, the art of listening and communicating with patients needs to be acquired with the supervision and support of trainers and mentors. Effective communication starts in the outpatient clinic. It is important to involve the patient in the decision making process, which means providing a balanced and honest view of the treatment possibilities for the specific condition, with associated benefits and shortcomings. Scientific societies are now including patients and representative in guidelines development and trials planning, meaning that in a near future it would be easier to discuss with the patients the outcomes that they would value more. A good doctor is the one who listens to the patients. We live in the era of Social Media, which offer a precious opportunity to meet people with similar interests, and to expand our cultural and social boundaries. Social Media have been used effectively by colorectal surgeons, to conduct research and to access scientific data more efficiently – e.g. by means of direct interaction with peers who authored the researches they are interested in. For patients, Social Media represent a mean to connect with those who underwent the same operation, or to know more about their condition by other patients. More importantly, Social Media have now become a platform to facilitate interactions between doctors, surgeons, researchers, and patients. However, the patient-doctor interaction ahead of surgery cannot be replaced by any other means than a quiet discussion in an adequately prepared environment. Being asked about the most important innovation of the recent years, Gregorio Marañón – a Spanish doctor, philosopher and writer – replied, after a short pause of reflection: ‘‘The chair’’. He meant, the chair allows the doctor to sit next to the patient, to explore and to listen to him/her. Along with a perfect knowledge of the disease treated, adequate training in communication skills and continued interaction with the patients will contribute to create a solid basis for the colorectal trainees to deal with patient anxieties. The art of communication will then be perfectioned with experience, by conversating with the patients in the outpatient clinic, by attending the wards after surgery, and by following up patients afterwards, with a true interest in understanding their perspective and feelings.