BENSALEM, Pa. — “Do you want to see your tendons?”

Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient’s wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility.

“That’s pretty neat,” the patient, Esther Voynow, managed to gasp.

The operation Dr. Ilyas performed, called a De Quervain’s release, is usually done with the patient under anesthesia. But Ms. Voynow, her medical inquisitiveness piqued and her distaste for anesthesia pronounced, had chosen to remain awake throughout, her forearm rendered numb with only an injection of a local anesthetic.

So she had been able to watch as Dr. Ilyas first sliced into her swollen right wrist, tugged gently at skin flaps, and then opened a small bloody crater, exposing the inflamed sheath that had trapped her tendons. Now she could see why her thumb and wrist had been relentlessly throbbing.

 As he scraped, Dr. Ilyas chatted with Ms. Voynow, trying to keep her calm. From a sound system, the Temptations crooned along, with “The Way You Do the Things You Do.”

More surgery is being performed with the patient awake and looking on, for both financial and medical reasons. But as surgical patients are electing to keep their eyes wide open, doctor-patient protocol has not kept pace with the new practice. Patients can become unnerved by a seemingly ominous silence, or put off by what passes for office humor. Doctors are only beginning to realize that when a patient is alert, it is just not O.K. to say: “Oops!” or “I wasn’t expecting that,” or even “Oh, my God, what are you doing?!” READ THE FULL ARTICLE HERE.