Surgeon-Patient Cross∼Talk: How It Happens, How to Fix It

Surgeon-patient communication is fraught with difficulties. Cross∼talk can be conceptualized as surgeons and patients speaking different languages, working out of different cerebral hemispheres. While as surgeons we principally function from our left brains, our patients are universally working from their right hemisphere, because the situation they find themselves in is new and overshadowed by extreme existential angst. Respecting patient autonomy is best done by shared decision-making, in which we attempt to bridge into the patient's right brain, openly exploring, and helping crystalize their values through a deliberative method that utilizes collaborative pushback. This approach is preferable to trying to drag them into our left-brained "fix it" mental model by informing them of the location in our well-worn surgical algorithm and asking them to choose between treatment options. Surrogates are under extreme psychosociospiritual duress, which can overwhelm and blunt their left-brained cognitive processing abilities (organizing information in working memory, evaluating options, and processing advice). However, this challenge can be overcome with empathy and by explaining the benefits and practice of substituted judgment during each family meeting. Whenever possible, the Palliative Triangle-surgeon, patient, family-should be established and executed preoperatively in high-stakes surgical scenarios to mitigate distress and prevent nonbeneficial value-incongruent over-treatment.