Early in his career as an anesthesiologist, David Broussard, MD, was puzzled by the varied reactions of patients following complications while under anesthesia. On the one hand, he observed certain patients becoming very angry after experiencing only minor complications, while others appeared surprisingly forgiving following major medical events. With experience, Dr. Broussard came to understand that the difference between an angry patient and an accomodating one strongly related to the way communication was handled in the aftermath of a complication. Dr. Broussard has since become a thought leader in critical conversations at Ochsner Health and participates in educating new physicians on effective communication when complications occur. His message has also been shared with attendees at ANESTHESIOLOGY® 2023.

Dr. Broussard advocates that anesthesiologists should take the lead on communication when the unexpected occurs. In a perfect world, Dr. Broussard said the surgeon and anesthesiologist would confer with the patient or family together, especially in the case of serious complications. Logistics and workflows often prevent that from happening, and in many cases, the surgeon is the first to communicate with the patient about a complication. The challenge becomes that many anesthesiologists then avoid approaching the patient once the surgeon has explained the complication, fearing they might make the situation worse.

“These conversations are not easy. You’ll find a hundred ways to try to talk yourself out of this, but it’s super important to push past that thought, show ownership of the situation, and be a participant in the patient’s recovery process. No one else can describe our business as well as we can. Even if we (the anesthesiologist) can’t be with the surgeon for the first conversation with the patient or family, we must take the very first opportunity to engage in this discussion.” This approach underlines the importance of anesthesiologists actively participating in dialogue with patients and families, especially to address and rectify any inaccuracies conveyed by others during initial conversations.

Dr. Broussard acknowledges that anesthesiologists typically have a disadvantage in the event of complications as they don’t usually have the same established relationships with patients as the surgeon does prior to the day of surgery.

Dr. Broussard shares a vital technique for building credibility during preoperative discussions, stating, “It’s crucial to show patients you’ve meticulously reviewed their medical history. Mentioning specifics, like previous operations, demonstrates thorough preparation and personal attention.” He emphasizes the importance of personalized communication, advising anesthesiologists to address family members by name and clearly outline what they can expect. “This not only fosters credibility but also prepares them for the surgery process, enhancing trust and smoothing any potential complications,” he adds. This approach goes a long way in establishing a positive rapport and setting a groundwork of trust and reassurance for patients and their families.

Using the preop interaction to connect with patients regarding their top fears about surgery gives the anesthesiologist patient-centered talking points for follow-up. Dr. Broussard recalled treating the brother of a bull rider who needed a minor surgery but who was terrified of postop nausea, as his brother (who had undergone multiple surgeries related to orthopedic injuries as a bull rider) told him that nausea was the worst part of having an operation. Sharing a personal connection through bull riding (Dr. Broussard had a cousin who was a champion bull rider), Dr. Broussard reassured his patient of several measures he would take to prevent him from experiencing nausea. Their prior discussion around bull riding was a natural conversation starter when Dr. Broussard dropped by the recovery room after surgery to check on his patient. The bull rider’s brother was thrilled to reveal that he wasn’t experiencing nausea and Dr. Broussard jokingly told him to call his brother with the good news.

It’s easy to be a good team player when surgeries go well, but Dr. Broussard’s goal in training new doctors is to ensure they have the right tools when the unexpected occurs. During these more difficult encounters, he advises physicians to follow a structured conversation. Essentially, this comes down to acknowledging your awareness of a possible complication, explaining what you did to prevent the complication from happening, and outlining the steps you took to mitigate any damage from the complication.

“Be as transparent as possible about what’s known up to that point and what information will develop over the next several hours or days,” Dr. Broussard recommended. “This sets the stage for follow-up conversations where gaps can be filled in later, such as results from lab tests or X-rays. You should also acknowledge that there are other things about the occurrence that you may never know.”

If patients are admitted to the hospital following a complication, the anesthesiologist should visit them every day. Hospitalized patients (and their families) are often shell-shocked during that initial conversation, so it’s crucial to reiterate points that may have been missed. Staying involved in the patient’s care following a complication is a powerful demonstration of how much you care about the patient. It also gives you the opportunity to re-explain or clarify aspects of the event that may have gotten confused along the way. Other health care workers may have given the patient slightly different information since the initial conversation, and these follow-up visits are a great opportunity to maintain the accuracy of the message.

A variation on the rhythm of follow-up for inpatients can also be applied to outpatients who experience complications. When the patient is discharged following a complication, Dr. Broussard typically calls the following day to check on them. If medical matters are not fully resolved, he follows up by phone every few days until they are. Establishing a rhythm of follow-up is difficult, he acknowledges, but worthwhile for physicians.

“It’s human nature to avoid bringing up a complication again if the first conversation with the patient goes reasonably well,” he said. “That instinct is wrong 99% of the time. A rhythm of follow-up demonstrates that the physician cares and prevents the patient from feeling abandoned. It’s often the patients who feel abandoned who later decide to pursue legal action.”