PSYCHOLOGY OF SURGICAL PATIENT
Undergoing a surgery is a major event in one’s life. Except the issue for which one is operated, the idea of undergoing a surgery raises a number of questions and is a source of anxiety.
The previous generations of surgeons were usually focusing exclusively on the technical surgical issue and the mechanistic way of solving it. Today, societies with organised health systems require from a modern Doctor a more ‘holistic’ approach in everyday practice. Body and soul are – and should be considered – interconnected and in constant interaction with each other. Therefore, a truly human approach means understanding the psychological state of the patient, be willing to solve any eventual questions and cultivate an atmosphere of trust between the doctor and the patient.
In a calm environment, maintaining confidentiality and a private form of communication, the doctor has to dedicate time and show interest in explaining all things pertaining to the surgery and offer psychological support.
The patients are often reluctant to accept reality and, not infrequently, ill-informed or sciolist about their condition. Having the disease is by itself a very psychologically stressful situation, where the patient demonstrates occasionally different psychological reactions. In view of a scheduled surgery, appears anxiety, concern for the outcome of the surgery or sometimes a depressing feeling. Thus, questions-fears arise daily, such as: is there a risk of not waking up after surgery, is there a risk of complications, what if I discover that I have cancer, is there a risk of having an ugly scar, and more. Accurate information provision by the Surgeon eliminates unreasonable fear that feeds on the absence of correct and sufficient information. The Surgeon must understand the psychodynamic mechanism of any reactions, and should thoroughly discuss all the stress-generating reasons one by one. This way, the patient’s trust towards the Surgeon will be reinforced, and at the same time the well informed patient’s self-confidence will build-up. The explanations provided by the doctor reassure the patient and reduce both stress and anxiety. Furthermore, provision of explicit data and logical argumentation offers the possibility of an objective view on reality.
In many cases, when the doctor suggests a surgery as the solution to the problem, some patients react with denial, a well-known defence mechanism. Thus, it is not a rare occurrence for individuals who have a health problem (either evident or not) and should undergo a surgery, to react, for example, in one of the following ways: “I have no health issues at all… What was found in my medical examinations was not something serious… I don’t care what the doctors say… I was fine till yesterday… People of my family have a strong organism… I have a feeling nothing bad is going to happen to me…” The outcome is, unfortunately, sad and quite common in the everyday practice of a doctor. In quite a few cases, if the patient would seek a surgical correction of their problem in time, unpredictable acute complications, that often emergently lead to the operation room in very deteriorated health and with a high risk of postoperative morbidity or mortality, would be avoided. Moreover, there are stories more or less known in every family of people around us who ignored an incipient warning sign of a malignant disease – whose surgical removal could offer a complete cure – to become an advanced, or final stage of cancer.
In particular, in thyroid or parathyroid surgery, the patient may easily “be in denial” of the problem, since even in an advanced stage, thyroid cancer may not be visible on the patient’s neck, may not have any symptoms, and the common hormonal examinations may continue to appear normal, while the only suspicions often arise from the ultrasound.
The particularity of a patient’s psychology concerning a thyroid operation lies in a) the visible anatomic region and the anxiety of the aesthetic result after surgery, b) our sensitivity in the region of the neck, where we feel that vital anatomic elements are, like the vocal cords, carotids, tracheas, c) knowing the connection between the thyroid and our metabolism and the stress of any weight change d) hormone imbalance – while the ailing thyroid is still there – resulting in nervousness, petulance, sentimentality etc.
A well informed patient is psychologically calm. The tactic employed by some doctors, of not referring to the delicate and dangerous parts of an operation, demonstrating everything as too easy and telling the patients what they want to hear, is dangerous and occasionally catastrophic. Clarifying all the details of the recovery phase keeps the patient informed and reduces stress. Finally, it is important that we give directions to the family, so that they can be useful to the recovering patient.
A common situation that negatively influences a patient, while there is no need to, who will potentially have to undergo a thyroid surgery, is hearing stories about (ostensibly similar) experiences from friends, acquaintances, and neighbours. We should always be aware that there are different thyroid conditions, various levels of importance of a condition, differences between patients’ organisms with different accompanying organic health problems and varying mentalities concerning discomfort or pain, but most of all there are different surgical techniques (modern, traditional), various technological surgical equipment (state-of-the-art, basic), different Surgeons (specialised, general)… This is the reason why, we should always discuss our own case only, with the Specialist Surgeon who will certify that he can undertake our surgery successfully.
Mr Karvounis has a special sensitivity in approaching patients with thyroid conditions. As an attending physician with experiential knowledge treating thousands of patients in a specialised Endocrine Surgery unit, with working experience in Greece and abroad, and having a friendly and warm personality with a pronounced element of humanity, understands the patient’s variety of feelings, communicates, reassures, informs, and always stands by the patient. In this daily, persistent and human patient encouragement he has the constant support, help and advice from his wife, a Psychologist.