SAN DIEGO Direct, honest, and consistent communication between a Mohs surgeon and his or her technician is necessary for a high-functioning, organized partnership, said Alex Lutz at a meeting sponsored by the American Society for Mohs Surgery.
Neither party should rely on assumptions regarding procedure. The physician should not assume that the technician has understood instructions and followed the proper process each time, nor should the technician assume that the physician has conducted the surgery the same way each time, said Mr. Lutz, a Mohs technician in Torrance, Calif.
The technician must be able to tell the surgeon that the technician has made a mistake and be honest enough to admit it, Mr. Lutz said. Likewise, the physician must be able to tell the technician if something went wrongif the technician didn't get enough of a base for the specimen or did something differently from the agreed-upon standards. "Without that sort of communication, errors will be made," Mr. Lutz said. "It's all about checks and balances."
With this kind of communication in place, the Mohs surgeon and the technician can keep the surgical practice organized by agreeing upon a standard way to process specimens. If something about a specimen doesn't make sense, both parties must feel comfortable asking questions in order to avoid errors. For example, the surgeon who usually puts double hatch marks to indicate 12:00 on a specimen may put them at 3:00 for some reason, causing confusion for the technician.
He offered several standardization tips to enhance physician-technician harmony.
For the physicians:
▸ Choose a method to denote a true 12:00; it can be a pattern of marks or something else.
▸ Bring specimens to the technician in a petri dish of saline to avoid dehydration.
▸ Develop a standard inking format and a standard staining regimen.
▸ Send the Mohs map to the technician along with the slides. "Don't get into the habit of making the map later; the technicians need it," Lutz said.
For the technicians:
▸ Pick up slides the same way each time, and determine the surgeon's preference as to whether they want the first cut closer to the frosted edge or the opposite.
▸ Note the time and location of all tissue cuts on the Mohs map.
▸ Process multiple specimens in an organized fashion. Technicians should label slides and place them in the cryostat the same way each time.