Why Explaining Each Step of a Procedure Reduces Patient Anxiety

Medical procedures involve an inherent power imbalance in information. The clinician performing a procedure knows exactly what is about to happen, when, and why. The patient, lying still and often unable to see what is occurring, knows none of this unless it is actively communicated to them. This gap between what the clinician knows and what the patient experiences is a genuine source of anxiety that is entirely addressable through something as simple as ongoing verbal communication during the procedure itself.

Dr. Sherief Elsayed, Consultant Spine Surgeon in Dubai, explains why he makes a deliberate practice of narrating his procedures to patients in real time, and the specific difference this makes.

The Question That Prompted This Explanation

Dr. Sherief Elsayed opens with the context: “I’ve just been asked why I speak to the patient whilst I’m doing the procedure, and actually it makes a world of difference to the patient if they know what to expect.”

This is a genuinely revealing detail. The practice of continuous verbal communication during a procedure is deliberate and considered enough that Dr. Sherief Elsayed has clearly thought through the reasoning behind it, to the point of being able to articulate it clearly when asked. This is not incidental chatter during a procedure. It is an intentional clinical communication strategy.

The Core Problem: Uncertainty Itself Is Distressing

Dr. Sherief Elsayed identifies the specific psychological mechanism at play: “They can’t see what’s coming or when it’s going to hurt.”

This captures something well established in the psychology of pain and anxiety: the anticipation of an unknown, unpredictable stimulus is frequently more distressing than the stimulus itself, once it actually occurs. A patient undergoing a procedure, particularly one involving local anaesthetic injections, needle insertion, or other invasive steps, is often lying in a position where they cannot see what the clinician’s hands are doing. Without verbal narration, every moment carries the uncertainty of not knowing whether the next sensation will be a light touch, a pressure, or a sharp, unexpected pain.

This state of sustained uncertainty activates a heightened, anticipatory anxiety response that can itself increase the perception of pain when it does occur, a well-documented phenomenon in pain science where psychological state directly modulates the subjective experience of a given physical stimulus.

The Specific Solution: Narrating What Is About to Happen

Dr. Sherief Elsayed describes exactly what this narration sounds like in practice: “If I tell them I’m coming on your right hand side now, sharp scratch, that’s the local anaesthetic needle going in, they know what to expect. There’s no surprise.”

This example illustrates several specific and deliberate communication techniques working together.

Spatial orientation: “I’m coming on your right hand side now” tells the patient exactly where on their body the next sensation will occur, removing the uncertainty of not knowing which part of their body is about to be touched or approached.

Accurate sensation description: “Sharp scratch” provides the patient with an accurate, specific expectation of what they are about to feel, using language that genuinely matches the actual sensory experience of a local anaesthetic injection, rather than either minimising it in a way that might feel dishonest when the sensation occurs, or exaggerating it in a way that would increase anxiety unnecessarily.

Explaining the purpose: “That’s the local anaesthetic needle going in” tells the patient not just what they will feel, but why, connecting the sensation to its clinical purpose within the overall procedure they have already consented to and understood in broader terms.

Why “No Surprise” Is the Key Phrase

Dr. Sherief Elsayed’s summary of the effect, “there’s no surprise,” identifies precisely the psychological mechanism that this communication strategy addresses.

The physiology of surprise and pain:

An unexpected, unannounced sensation triggers a startle response, involving sudden muscle tension, a spike in sympathetic nervous system activity, and often an exaggerated subjective experience of the stimulus compared to an anticipated one of identical physical intensity. This is why a needle that arrives without warning often feels more painful and more distressing than one that has been clearly announced beforehand, even when the physical stimulus itself is identical.

The value of anticipation, done correctly:

Importantly, this is not about creating anxious anticipation through vague, ominous warnings (“this next part might really hurt”). It is about providing specific, accurate, immediately relevant information that allows the patient’s nervous system to prepare appropriately for a known, expected sensation rather than reacting to an unexpected one. This distinction, between helpful specific anticipation and unhelpful vague dread, is central to why this communication technique works as intended.

The Broader Evidence Base for This Approach

Dr. Sherief Elsayed’s clinical practice reflects a body of evidence within medical communication and pain management research supporting exactly this kind of procedural transparency.

Reduced anxiety scores: Studies examining patient-reported anxiety during medical procedures consistently show lower anxiety levels when clinicians provide ongoing verbal communication about what is happening and what is about to happen, compared to procedures conducted in relative silence.

Reduced perceived pain intensity: Beyond anxiety specifically, some research suggests that patients who are accurately informed about upcoming sensations report lower pain intensity ratings for the same physical stimulus, consistent with the broader understanding that psychological preparation genuinely modulates the subjective pain experience.

Improved patient satisfaction and trust: Patients consistently report higher satisfaction with procedures where they felt informed and prepared throughout, and this communication approach contributes to the broader clinical relationship and trust discussed in the earlier article on rapport as a criterion for choosing a spinal surgeon.

How This Applies Across Different Procedures in Spine Care

This principle of continuous, specific verbal communication applies across the range of procedures discussed throughout this blog series. A Spine Pre-Op Specialist in Dubai applies this same approach to every image-guided procedure performed. discussed throughout this blog series, from diagnostic and therapeutic injections such as the facet joint injections covered in earlier articles, to more involved interventional procedures, to elements of surgery performed under local anaesthesia or sedation where the patient remains conscious and aware throughout.

For procedures performed under general anaesthesia, where the patient is unconscious throughout the procedure itself, this narration technique is most relevant to the pre-procedure preparation phase: explaining what the patient will experience as they are positioned, as monitoring equipment is attached, and as anaesthesia is induced, ensuring that the period during which the patient remains conscious and aware is handled with the same communicative transparency.

Why This Matters Specifically for Spine Procedures

Many of the diagnostic and therapeutic procedures central to spine care, including facet joint injections, epidural steroid injections, and nerve root blocks, are performed with the patient awake, under local anaesthesia, precisely the scenario where this kind of ongoing narration has its greatest impact. A Spine Doctor in Dubai performing these image-guided procedures, which require the patient to remain still and often to provide feedback about symptom reproduction as covered in the earlier article on facet joint diagnostic injections, benefits directly from a calm, well-informed, and cooperative patient throughout.

What Patients Can Ask For

Patients who have previously experienced anxiety during medical procedures, or who simply prefer to understand what is happening throughout, can reasonably and directly ask their treating clinician to explain each step as it occurs, following exactly the model Dr. Sherief Elsayed describes. This is an entirely reasonable request, and a clinician genuinely committed to patient-centred care should welcome and accommodate it readily. A Consultant Spine Surgeon in Dubai welcomes this kind of direct request from patients.

What to ask for specifically:

Requesting that the clinician describe where on the body each step will occur, what specific sensation to expect, and a brief explanation of the purpose of each step, mirrors exactly the communication pattern Dr. Sherief Elsayed describes as his own standard practice.

UAE-Specific Context

Within the UAE’s diverse patient population, including many patients for whom the healthcare encounter may be occurring in a language or cultural context different from their home country, this kind of clear, specific procedural communication takes on additional importance in building trust and reducing the anxiety that can be compounded by unfamiliarity with the specific clinical environment or process. A UAE Spine Surgeon who prioritises this level of communication reflects a broader commitment to patient-centred care that extends throughout the entire clinical encounter, not only the diagnostic and treatment decisions themselves.

Expert Summary

Continuous, specific verbal narration during a medical procedure directly addresses the anxiety created by uncertainty, allowing a patient to anticipate exactly what is about to happen, where, and why, rather than experiencing each sensation as an unexpected surprise. Dr. Sherief Elsayed’s specific practice, describing the location, the expected sensation, and the purpose of each step as it occurs, reflects both established evidence in pain and anxiety research and a genuine commitment to making the clinical encounter as comfortable and transparent as possible for the patient throughout.