First, my disclaimer. While I do spend quite a bit of time thinking about these things—and reflecting on how well I’m doing, asking for feedback, and reading (each of which I highly encourage everyone to do)—I certainly do not pretend to have all the answers. Rather, I present this discussion to suggest a framework, perhaps point out some new thoughts, and provide a stimulus to make you want to improve your communication skills.

Sensitivity is an important skill for all physicians. In the abstract, we recognize the importance of good communication with our patients and families, but we sometimes find it hard to put time and energy into this aspect of our many professional responsibilities. Years of difficult and challenging training, a high-stress work environment, and the reality of too much work and too little time contributed to the big screen image of the neurosurgeon rushing up to the family, delivering bad news crisply, and rushing off to save another life. While few of us fit this movie profile perfectly, stereotypes exist for a reason. Additionally, very few physicians I have met make it a point to study and assess their communication skills with the intent to improve.

As we are acutely aware, neurosurgery comprises some of the highest of the highs and lowest of the lows in medicine, for several reasons. The central nervous system is an organ system that people care deeply about, one that has wide-ranging effects on very important functions, and that many patients and a fair percentage of referring physicians find just a bit terrifying. Additionally, many neurosurgical problems present abruptly—one day you are perfectly fine and the next you have a seizure and within hours are told you have a brain tumor. Aneurysmal rupture and cerebral abscesses present without warning and often without prodrome. The lack of ability to prepare for this life-changing event contributes to heightened anxiety on the part of the patient and family. The severely wounded polytrauma patient fits this characterization perfectly. Adding to the stress, an inordinately high percentage of trauma occurs in the young resulting in the loss of youthful vigor or even decades of life.

Under these circumstances, neurosurgeons and other healthcare professionals are often forgiven for being candid, brusque, or downright rude. Patients, families, and staff act as enablers of less than optimal communication on the part of surgeons with comments such as: “but he’s a great surgeon, he’s just really busy, do not worry about his bedside manner.”