Green Health & Wellness Scarlett McNally: Using clear information as a patient and surgeon – GWC Mag gwcmagOctober 18, 2023047 views Scarlett McNally, professor Eastbourne scarlettmcnally{at}cantab.netFollow Scarlett on X/Twitter @scarlettmcnally I wore a wig for a year after I had a stem cell transplant. The wig wasn’t for vanity as much as not wanting to be defined by having had chemotherapy. I didn’t want a label, stigma, judgment, or pity. I’ve written a pamphlet for surgeons on Avoiding Unconscious Bias,1 and I know that being perceived to fit in is sometimes easier than being your authentic self. Returning to work as a surgeon, I treasured each interaction with patients, working alongside colleagues old and new, in a role I thought I’d never do again. In medicine, and more widely, we’re stuck in a paradox. We have access to excessive amounts of information, yet simple messages get drowned out. Through my experience as both a patient and a surgeon I’ve come to value clearly communicated health information. Clear information helps to lessen taboos and empower patients and staff. I have some practical tips that could benefit others wearing wigs after chemotherapy: wear cardigans, not jumpers; get a Radar key for access to disability toilets so that you can adjust your wig in private; your hair grows about 10 cm a year, and after chemotherapy it may grow back very curly. Similarly, when preparing for my hip replacement I used the Fitter Better Sooner leaflet2 that I’d helped to write with the Centre for Perioperative Care, and the advice it gave about getting active truly improved my ability to leave hospital rapidly and regain strength after the operation. Every patient’s experience is different. But I still support standardised pathways that empower patients and help all staff to feel part of the team and share general information and skills. If pathways aren’t agreed and written down a patient’s journey can feel unpredictable, so that they remain passive and feel powerless. Having information in writing clarifies practice: patient information resources can explain care pathways for staff and patients.3 And standardised pathways allow us to identify the steps where each patient and their medical needs are unique. For example, each pathway should include prompts for good care and should define “red flags” where a patient may deviate from the standard trajectory. For patients, long periods of waiting are interspersed with rushed interactions with healthcare staff. We need information about each patient in advance: the Professional Record Standards Body has a helpful “About Me” template for patients to include important personal details for healthcare staff, explaining the patient’s unique background and values.4 Options and complexity I worry that the “one stop shop” approach to healthcare adds too much pressure and doesn’t allow a cooling-off period for patients to reflect. Better preparation and perioperative care, involving comprehensive and clear communication, could help the 14% of patients who express regret after surgery5 and the 12% who have a complication after it.67 Even in uncertainty, there’s usually a finite number of options for treatments and care. But healthcare should prepare and allow input from patients in advance. Shared decision making is mandatory in line with the National Institute for Health and Care Excellence’s guideline NG197.8 Patients need to be primed to ask about “BRAN”—the benefits, risks, alternatives, and non-treatment options9 of any proposed treatment. They should also be ready to take steps to optimise their health before treatment to help improve outcomes, as I did through exercise before my hip replacement.10 The danger with standardised pathways is that policy makers oversimplify health and healthcare. As we’re short of time and the workforce is stretched, we need an empowered team working together, to agreed protocols. But crucially, the team and pathway should be led by senior clinicians who understand the options and complexity for each patient, rather than multiple autonomous practitioners working outside a team. As a patient and a surgeon, I trust the NHS to deliver—but it needs to give clear information about what health means for patients and teams. Footnotes Competing interests: Scarlett McNally is a consultant orthopaedic surgeon, deputy director at the Centre for Perioperative Care, and president of the Medical Women’s Federation. Provenance and peer review: Commissioned, not externally peer reviewed.