Monday, October 03, 2005

Clowns in the OR

According to this report, a new Italian study has found that the presence of a clown in the operating room may help to ease the anxiety of young patients and their parents. Unfortunately, the report does not reference the study directly, authored by Laura Vagnoli of Anna Meyer Children's Hospital in Florence, so we will have to await its formal publication to get any meaningful information. The study included 40 children, with ages ranging from 4 months to 4 years, who were taken to the OR with at least one parent, where a clown was present.

OK, OK, just stop right there! It's just not right to call my anesthesia colleagues clowns!
As it turns out, the study reported that the clowns were successful in distracting the patients until anesthesia was induced, and that the clown's presence "significantly reduced anxiety levels for both child and parent." I'm not sure how the anxiety level was measured, but I'm pretty sure it had to be a fairly subjective evaluation.

I enjoyed my pediatric surgery rotations during residency immensely, and considered pursuing a fellowship fairly strongly for a while (until long-suffering SWIMBO pointed out that we would by then have 3 surglings, with an intense fellowship relegating her to a few more years as essentially a single parent). I can categorically state that there was never a time during those rotations that I felt having a clown in the OR would be of any help whatsoever. It would be yet another distraction that would keep the staff from proceeding in a normal, routine fashion -- when things go as they are supposed to, the stress experienced by the nurses, anesthesiologists, and surgeons is vastly reduced. So, I anticipated this comment:
"The questionnaire for health professionals indicated that the clowns were a benefit to the child, but the majority of staff was opposed to continuing the program because of perceived interference with the procedures of the operating room."
The concept behind this type of anxiety-reducing suggestion is a thoughtful and well-intended one --- we in medicine need to be cognizant of, and try to reduce, patient and family anxiety. Another example of this type of thinking is displayed by those who advocate the presence of family members in the trauma resuscitation room (i.e., while a critically injured patient is being cared for). My thoughts on this are similar to those of Dr. Ken Mattox of Baylor Medical School:
In my view, this is a sick discussion. Any one who is pushing the family members to be present at the time of a trauma resuscitation, including open chests in the shock room, either has not been there or has a special problem of their own. This is a non-subject, families simply should not be there during the heat of the battle with blood and knives are flying. They simply would not understand and it would create more hurt and confusion than it would cause understanding and healing. Lets get on to another subject.
I think we do our best work when the team assembled is allowed to proceed as expediently as possible, with as few distractions as possible ---- and that leads to better outcomes. Anyone feel differently? Would it be better if I showed up in the OR wearing this?
Just asking! I'd appreciate thoughts from those who agree, and those who don't. A tip of the clown hat to SondraK.