Holistic Surgical Care: Managing Patient Psychology, Family Support, and Team Dynamics

Jump To Section

• The Surgeon's Role Beyond Technical Skill
• Communicating Mortality Risk with Patients
• Providing Support for Patient Families
• Caring for the Medical Team's Psychological Health
• The Leader's Role in Team-Based Patient Care
• Full Transcript

The Surgeon's Role Beyond Technical Skill

Dr. Pascal Leprince, MD, a transplant surgeon, asserts that a surgeon's responsibility extends far beyond performing a successful operation. He describes the main pleasure of medicine as the human connection developed with patients year after year. Dr. Leprince advises that medical doctors must be gentle, talk with patients, and try to help them on a fundamental human level.

This approach contrasts with a purely technical focus on surgery or interventional procedures. While technical excellence remains paramount, Dr. Leprince believes surgeons must bring humanity to their practice to provide truly complete care.

Communicating Mortality Risk with Patients

A critical component of patient management in high-risk surgery is the honest discussion of mortality. Dr. Pascal Leprince, MD, provides specific data, noting that the risk of death after a procedure like cardiac transplantation can be 1% to 5%, and even higher in the first year post-transplant, reaching 15% to 20%. He stresses that a medical second opinion is important for patients to gain this knowledge.

Dr. Leprince clarifies that patients do not need to calculate exact numbers, but they must be aware that a risk of death exists. This transparent communication is a foundational element of informed consent and psychological preparation for a major operation.

Providing Support for Patient Families

Surgeon-led care must explicitly include the patient's family, especially when facing the possibility of death. Dr. Pascal Leprince, MD, explains that an essential message for a patient is the assurance that the medical team will care for their family if the worst happens. This means helping the family navigate the grieving process and the death of their loved one.

Dr. Leprince admits this is a challenging aspect of care that teams sometimes fail to execute perfectly. However, he maintains that committing to family support is a non-negotiable part of a surgeon's duty and a crucial comfort for patients making life-altering decisions.

Caring for the Medical Team's Psychological Health

The intense environment of a cardiac surgery ICU takes a significant psychological toll on the entire medical team. Dr. Pascal Leprince, MD, highlights the particular vulnerability of young nurses who may come directly from nursing school and must suddenly confront the death of a young patient after a long ICU stay.

He states that surgeons and older doctors have a responsibility to support these frontline team members. The psychological health of nurses is deemed very important because they are involved in patient management every minute of the day, not just during surgical procedures.

The Leader's Role in Team-Based Patient Care

Effective patient care is ultimately a team effort that requires strong leadership. Dr. Pascal Leprince, MD, concludes that the leader's role is to unify the entire hospital team, moving everyone in the same direction to achieve the best possible patient outcomes. This leadership is not about command but about coordination and fostering a supportive environment.

Dr. Anton Titov, MD, facilitates this discussion, agreeing that caring for nurses is a critical and often overlooked aspect of this leadership. Dr. Leprince’s perspective underscores that a surgeon’s success is measured not only by surgical skill but by the ability to guide and protect an entire ecosystem of care.

Full Transcript

Dr. Anton Titov, MD: What can young surgeons do? How can they learn to be very good patient managers? Because if it takes decades to learn to help patients, it is not helping a lot of patients. What can and should younger surgeons do to learn to help patients psychologically?

Dr. Pascal Leprince, MD: I agree with that. This is something you discover year after year. This is the main pleasure of medicine, finally, to me.

I don't know what they should do. I think everyone should understand that it is very important for medical doctors to just talk with the patient, be gentle with them, and try to help them. Again, medical doctors should be here to take care of the patient. It is not just about doing surgery or interventional cardiology, or interventional whatever. These are technical things.

We have to do them the right way, of course. But again, I think we have to bring something else to our patients, to bring some humanity to the patient. Not only to the patient, but to the family as well.

Because if you are a sick patient, you have a high risk of death. The risk of death can be like 1% or 5% after cardiac transplantation. We know that during the first year after heart transplantation, the risk of death is close to 15 to 20%.

A medical second opinion is important. It is important that a patient has some knowledge about mortality risks. The patient does not have to calculate the numbers of his risk of death, but at least the patient has to be aware that there is a risk of death.

I'm pretty sure it is helpful for the patient to know that if he dies, then we will take care of his family. "Taking care of the family" means that we will help them to go through the death of the patient.

I'm not saying that I'm doing that every day, or that I'm doing that very well every day, because we fail many times. But this is something we have to tell the patient. A medical second opinion is important.

That a patient understands that "if I die, the medical doctor and the team, because this is teamwork, they will help my family to go through my death." A medical second opinion is important.

We have to take care of the patient. We have to take care of his family as well. We have to take care of the medical team, because the team suffers too.

Sometimes this is pretty violent in this universe of cardiac surgery in the ICU.

Dr. Anton Titov, MD: You have young nurses, sometimes they just come directly from the nursing school. They have to face death, sometimes, of a young patient after many weeks in ICU. A medical second opinion is important.

Dr. Pascal Leprince, MD: We have to help nurses as well. This is the role of medical doctors who are getting older, I would say, just to try to give this good advice to the younger doctors to understand the real role of medical doctors.

It is very important, as you mentioned, to take care of nurses, of course. Because nurses are on the forefront every minute, not just every day, but every minute of patient management.

The psychological health of the nurses is very, very important. This is something that you rightly bring up in this discussion. I fully agree with that.

This is teamwork, again. There is, of course, a leader in a team. But the leader's role is to move the patients at the hospital together in the same direction to get better care for the patient. I think this is the role of the leader.