Tech in Surgery Prep / Unit 22 TSC 548 review, 2 to 3 minutes
A Surgeon Who Doesn't Ask
The idea
A worked example, constructed for this course, shows a scrub person working with a surgeon who rarely says what they want next.
In practice
The surgeon is experienced and quiet and tends to hold out a hand without speaking. Early in the case, Toni, the scrub person, hesitates: the hand is held out, palm up, and Toni is not sure what is wanted. Toni asks, briefly, whether the surgeon wants scissors or a clamp. The surgeon says scissors. Toni notices the surgeon's pattern over the next few minutes: after dissecting with scissors, the hand comes back for a clamp; after clamping, a tie. Toni starts having the next item ready and offers it when the hand appears, saying its name as it is passed, such as clamp, or tie. When Toni is unsure, Toni still asks rather than guessing. Midway, the surgeon changes approach and asks for a different retractor; Toni asks the circulating nurse for it, and adds it to the count. After the case, the surgeon tells Toni that saying the instrument's name as it was passed was helpful. At the next case with this surgeon, Toni reviews the preference card more closely and asks the circulating nurse about the surgeon's usual sequence.
Where people slip
Anticipation is built from three things: knowing the procedure, watching the surgeon, and asking when unsure. Naming each instrument as it is passed turns a silent exchange into a checked one, and protects both people from a wrong pass. Over time the scrub person learns the surgeon's habits, but the habit of asking when unsure never goes away, because a confident wrong pass is worse than a short question.
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