Surgeon–patient communication during awake procedures

Claire S. Smith, M.F.A., Kristina Guyton, M.D., Joseph J. Pariser, M.D., Mark Siegler, M.D., Nancy Schindler, M.D. M.H.P.E., Alexander Langerman, M.D. S.M., F.A.C.S.


  • Surgeons make use of diverse strategies for communication during awake procedures.
  • The awake patient’s presence impacts surgeons’ communication with staff and trainees.
  • Surgeons describe challenges in balancing teaching and maintaining patient comfort.



Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature.


Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures. Three researchers used the constant comparative method to transcribe, code, and review interviews until saturation was reached.


Twenty-three surgeons described the advantages and disadvantages of awake procedures, their communication with the awake patient, their interactions with staff and with trainees, the environment of awake procedures, and how communication in this context is taught and learned.


Surgeons recognized communication during awake procedures as important and reported varied strategies for ensuring patient comfort in this context. However, they also acknowledged challenges with multiparty communication during awake procedures, especially in balancing commitments to teaching with their duty to comfort the patient.

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