By Abram Kirschenbaum, MD

In a busy hand surgery practice, good communication sometimes depends on being able to do more than one thing at a time. I run very hands-on, small-shop office hours. By this I mean I often draw up my own injections after interviewing and examining a patient, which frees staff members to attend to other matters. One useful tool I have found is to have a box of small, single-use markers in each exam room (the same ones used to mark patients for surgery pre-operatively).  While I describe the pathology and injection procedure to the patient, I take time to mark the site with a dot and to draw local landmarks, if needed.  An alcohol wipe passed over the mark does not erase it completely, but does dull the purple color slightly and turns the alcohol wipe purple so there is never any doubt about whether the skin is prepped prior to injection (a doubt that can easily creep into your mind if you are discussing the pathomechanics of a patient’s problems and answering a patient’s questions, all while getting things ready for the injection). The mark can also serve to show where an assistant where to aim the ethyl chloride spray (yes, I still use it despite recent studies questioning its effectiveness). These little reminders help me focus more on communication with my patients, while not sacrificing injection accuracy or efficiency.