A Team Sport
Plastic surgery isn’t a single-person endeavor. While the plastic surgeon is the one planning the operation and holding the scalpel, it takes a team for a major case to go smoothly and safely. A typical surgical team consists of:
- A Board-Certified Physician Anesthesiologist or a Certified Registered Nurse Anesthetist for cases done under general anesthesia or heavy sedation
- A Scrub Technician or Scrub Nurse)
- A Circulator
- A Recovery Room Nurse
- Oh, yes, and the Plastic Surgeon
Unless a case is being done under local anesthesia with (at most) light sedation, an anesthesiologist looks after the patient’s comfort, including pain control, vital signs, and body temperature. With the right amount of medication, the patient is pain-free during surgery and wakes up quickly and smoothly after surgery is over. Although they aren't in the limelight, anesthesiologists literally have their finger on the pulse. Their total focus is on the patient. Monitoring a heavily sedated patient while simultaneously operating cannot be done well by the plastic surgeon. The surgeon who offers a major procedure for a low fee by not hiring an anesthesiologist is increasing the patient's risks.
The Scrub Tech (Scrub Nurse)
During routine cases, the surgeon holds out a hand, sometimes without looking away from the field, and the best Scrub Tech places the desired instrument into the palm. Not a word is exchanged. A tech who is less attentive adds time to the case as the surgeon waits for the necessary instrument. For longer cases, added time can increase the chances of surgical complications. The organized, prepared surgical tech lowers the surgeon’s stress level. They may be invisible to most patients, but the best are like guardian angels, moving the case along and supporting the surgeon.
The circulator helps the surgical tech set up the case before surgery, helps the anesthesiologist, records data about the case, and opens sutures and instruments onto the sterile field during surgery. The best look for small clues during surgery. Is the surgical tech running low on suture? Is the saline irrigation nearly gone? If so, she's on it!
The Recovery Room Nurse
After surgery is over, the patient is transferred from the operating room to the Recovery Room. Recovery Room Nurse assess and supports the patient as she awakens, cares for the wounds (icing and elevation), and checks for signs of problems such as bleeding. The exceptional Recovery Room Nurse transitions the patient from sleepy to wide-awake within an hour, speaks with the caretaker, reviews postoperative instructions, and makes sure the patient is in safe hands.
The surgeon is, by default, the leader of the surgical team. However, leadership doesn’t mean dictatorship. The best surgeons show their team members respect so that anyone feels comfortable speaking up and making a suggestion or identifying a problem. Communication involves both speaking and listening. Just as the best scrub tech anticipates and moves the case along, the best surgeon comes fully prepared, having planned out the case, checked a patient’s labs, ordered implants or other specific items ahead of time so there are no unnecessary delays. The case itself is centered on delivering the best possible result, even if it means taking out all freshly placed sutures and starting over again. Patience and exactitude go hand in hand.
After the surgical team is long gone and the patient is home, the caretaker plays the most important role. By monitoring pain medications and looking for potential problems, such as a hematoma, the caretaker facilitates the patient’s recovery. Should a problem arise, he or she calls the surgeon, who determines the level of concern. An alert caretaker can keep a small problem from becoming a big problem.
A surgical team that works together with a singular goal of taking the best care of the patient flows like a team rowing in unison on the Henley, with total focus and no ego. Resources: Choose the right surgeon. You got Local Anesthesia...but the Wrong Operation!