Throughout the years, I’ve heard countless general practitioners say, “I hate surgery,” “Surgery stresses me out,” or “I could never do what you do.” Yet, you don’t have to be an uber-experienced, cool-as-a-cucumber surgical rock star to enjoy surgery. Actually, it’s normal to feel stress, at least early on in your career or before a truly challenging case. But you really shouldn’t have massive stress colitis the night before a large dog spay after 10 years in practice. With time and experience, the stress should decrease. The following 12 simple strategies should help reduce your stress before, during, and after surgery. 1) Checklist You should have checklists that include OR preparation, surgical instrument and supplies, patient preparation, and patient recovery, along with OR and instrument cleanup. Having your own checklists in place helps your team and gives you confidence everything will be handled professionally so you can focus on what only you can perform: the surgery. 2) Team Of course, this likely won’t happen overnight, but make sure all your surgery nurses are adequately and equally trained. That way, no matter who helps you, your patient is in good hands. Train nurses on safe induction, proper monitoring, regular logging, correction of abnormal values, and CPR. Being able to focus on the surgery itself and to not have to worry about anesthesia is priceless. Surgery nurses should understand that just because the mean arterial pressure (MAP) is 50 or the CO2 is 60 doesn’t mean the patient is about to arrest. Empower them to know how to recognize abnormalities and how to address them, without losing their cool and without interrupting you. That said, they should feel free to ask you questions if there is a true crisis. 3) Referral Refer patients if you do not have the correct equipment or anesthesia know-how to perform a procedure properly. Consider the following: Do you have a high-risk surgical patient and only a pulse oximetry to monitor? Refer it. Will the patient require a chest tube and 24-hour care, but your staff leaves at 5 p.m.? Refer it. Does a fracture require plating, but all you have is pins? Refer it. Knowing the limitations of your facility and acknowledging a patient requires and deserves more than you can provide are critical to patient care. 4) Limitations Be comfortable with your personal limitations. If you’ve spent the last 72 hours stressed out in anticipation of performing a procedure for the first time on a lawyer’s pet, this might not be the patient to learn on. Enlist the help of a more experienced colleague or specialist instead. There are many wet labs and CE opportunities where you can learn advanced procedures. Performing surgery on a client’s pet may not be the appropriate time to go outside your skill set. 5) Knowledge Know your anatomy, approach, and complications. Something as simple as being 1 cm lateral to the recommended incision location can cause you a world of trouble. Reviewing the local anatomy to minimize trauma or remove a body part unintentionally will avoid a lot of heartache. Familiarizing yourself and the owner with potential complications ensures you are ready if anything comes up. And for goodness sake, make sure you can see what you are doing. No one can perform surgery well without proper visualization. This includes an incision that is long enough and has proper retraction. And don’t forget sufficient lighting and magnification when needed. You do need a minimal amount of experience to know not to panic because you encounter a few “bleeders.” They don’t all need to be dealt with. After all, there is a very good reason surgeons say, “All bleeders stop—eventually.” 6) Organization One thing you can absolutely control is your workspace. Keep your instruments neat and tidy. Always organize your instrument table in the same manner, so you know where to find the instrument you need. I’m not suggesting you have obsessive compulsive disorder. However, I am saying you should be prepared so you can find the right instrument at the right time, without getting irritated and wondering who stole the hemostat you need and is likely right under your nose. Think about it… would you prefer your own surgeon be organized or messy? 7) Music Music is an interesting topic. It is banned in some ORs, but welcome in others. This is a very personal preference. You can choose music that helps you focus or relaxes you. Just make sure it is not loud to the point of masking the soothing beeping of your monitoring equipment. 8) Plan B Have a Plan B and ideally a Plan C. Surgery can sometimes throw you a curveball. If your initial diagnosis is incorrect or your plan does not work, you need to be able to adapt calmly. If you perform a cystotomy, but cannot unblock the patient who now requires a urethrostomy, you should not perform the procedure. If you remove a foreign body, but are unable to perform a resection and anastomosis, you should not perform foreign body procedures. Refer them instead. The list goes on and on. At a minimum, you should have on standby a more experienced colleague, who can offer guidance or even scrub in if you need help. 9) Time Schedule adequate time for your procedures. Knowing you will have three appointments waiting for you if your surgery takes longer than anticipated will cause most people’s stress level to be sky-high. Make sure you plan your surgeries so you have extra time if needed. 10) Mindfulness Practice mindfulness. A 2019 study1 showed fourth-year veterinary students’ salivary cortisol decreased after a five-minute breathing exercise immediately prior to surgery. Countless studies in human medicine have shown mindfulness and meditation reduce blood pressure, stress, and anxiety. There are many websites and apps that can guide you with the process. 11) Well-being Physical well-being should always be prioritized. You will not be able to excel in surgery if you’re exhausted, dehydrated, hungry, or have to use the restroom. As the saying goes, “You cannot pour from an empty cup.” Take care of yourself. The patients, their records, those call-backs, and prescription requests will still be there in five minutes. According to very annoying scientific studies, coffee and cupcakes are not nutritionally complete. 12) Instructions Proper education of clients is critical after surgery. You can do the most amazing job in the OR only to have it fall apart if your client is noncompliant. Before the procedure, take the time to make sure pet owners are set up at home and ready to do their part correctly. It’s unrealistic to expect anything to be completely stress-free in veterinary medicine. However, there are simple steps you can take to limit unnecessary and preventable stress. If that doesn’t work, it’s perfectly acceptable for you to focus on other interests you actually enjoy, such as dentistry or behavior. Surgery is not for everyone. The area of veterinary medicine you practice needs to fit your personality and your comfort level. Ultimately, if you perform surgery the safe and smart way, you will gain invaluable experience and confidence, your stress level will decrease, and your happiness will increase. Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and author whose traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his website at DrPhilZeltzman.com. He also is cofounder of Veterinary Financial Summit, an online community and conference dedicated to personal and practice finance (vetfinancialsummit.com). AJ Debiasse, a technician in Blairstown, N.J., contributed to this article. References 1 “Effect of a mindfulness exercise on stress in veterinary students performing surgery,” BS Stevens et al. Vet. Surgery 2019, Vol 48, N 3, p. 360-366.
