Tips to keep your patients relaxed

Charlene Lam, MD, MPH, discusses the usefulness of wound closure procedures Friday during “Simple Tricks and Practical Tips to Optimize the Surgical Experience for You and Your Patients.”

In the course of everyday work, people become creative, finding ways to save time and get better results. Friday, four dermatologists regaled a large, interested audience as they reviewed favorite tips — from working positions to folding drapes to helping patients relax — during “Simple Tricks and Practical Tips to Optimize the Surgical Experience for You and Your Patients.”

Charlene Lam, MD, MPH, kicked off the discussion on a technical note by showing images of closure techniques she relies on in difficult situations. This included the purse string, which she said she likes to use on skin with laxity, concavities, ears, the scalp, and full-thickness graft donor sites.

Dr. Lam also advised on the importance of correct positioning. A surgeon who is in an uncomfortable position may hurry through a procedure, which takes a toll on the body and could lead to medical complications in the patient. It is best to stand straight and look down at the patient with the head and neck at an angle between 15 and 40 degrees.

A survey by the American College of Mohs Surgery showed that 90 percent of medical respondents reported some form of musculoskeletal symptoms or injuries, Dr. Lam said. The most common problem areas were the neck (65 percent), lower back (63 percent), shoulders (61 percent), and upper back (53 percent).

Allison Vidimos, MD, RPh, chairman of the department of dermatology at Cleveland Clinic, provided tips ranging from local anesthesia to protecting against eye injuries when using lasers.

For local anesthesia, Dr. Vidimos prefers to improve the patient experience by using lidocaine to begin numbing slowly before using bupivacaine. She then recommends using acetaminophen postoperatively to reduce pain.

Lasers are a danger to the eyes of both patients and health care professionals, so wearing goggles is vital, she said. It is also important to wear different goggles for different types of lasers. Dr. Vidimos recommended marking them clearly, even using color-coded dots on goggles to match dots on the equipment.

Finally, Dr. Vidimos warned the audience about Aschner reflex, in which a patient’s pulse rate can decrease when traction is applied to the ocular muscles or when the eyeball is compressed. She said she became aware of this reflex when a patient coded during a minor procedure she was observing.

Following Dr. Vidimos to the dais was Elizabeth M. Billingsley, MD, who talked about the importance of using drapes. She advocates for the liberal use of drapes to keep sutures and equipment sterile by keeping them from touching tables and chairs during a procedure.

Dr. Billingsley said she asks patients if they are claustrophobic before beginning a procedure because some patients can become anxious when covered by drapes.

“Make sure the patient can breathe, and if you cover the eyes, don’t push on the eyeballs,” said Dr. Billingsley, a professor of dermatology at Penn State Hershey Medical Center.

Marc D. Brown, MD, professor of dermatology and oncology at the University of Rochester, described processes his office uses to keep surgical patients relaxed.

“Stress impairs wound healing by as much as 40 percent,” he said. He urged keeping patients as stress-free as possible, including answering questions from anxious patients following the procedure. 

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