Why operating rooms are cold (not what you thought) 

Thank you. I manage construction in hospitals. It's worth pointing out that in OR construction, we strive to have more supply duct surface area in the ceiling (over the patients) so we can get those 20 air changes done with slower air speed. And we balance the supply to be the same speed across the entire face so that we create a laminar flow (of HEPA filtered air) across the patient (and sterile field) to also lower SSI. Another factor is making that air speed slow enough to reduce noise in the OR, but, fast enough so that movement around the Sterile field doesn't stir up dirty air around the patient while keeping the OR positively pressured (relative to the corridor). Thanks again, your content really helps me to understand why it's important to construct OR's the way we do.

Everytime I go in for surgery I have to tell everyone involved especially the anesthesiologist: "I have an upper spinal injury and can't regulate my body temperaturen so I'll need that really cool heated blanket thing, and you will need to watch me." The anesthesiologist always appreciates the heads up that I'm a lizard person and not to ever trust my body temp.

After a literal 48 surgeries, I’m finally getting an explanation. I was always flippant with my Doctors that they were taking me to the morgue instead of the operating room. Thanks for the important information.

I quit my surgical nursing position because I kept getting very ill from the constant cold. I constantly shivered and couldn't control my body movements. It also caused me to feel a frequent need to empty my bladder. I never questioned the cold temperature because my nursing instructors taught us it was to lower the chance of infection for patients. Wow!

I commented that I didn't think the surgery was going to happen in a meat locker. The nurse went into the blanket heater and returned with 3 heated blankets. The doctor was wearing all the crap you were saying, the nurse even said he would overheat if it wasn't that cold. No joke, that surgeon had two helpers getting all the stuff on and when he came to visit me afterwards in recovery, he looked like he was playing basketball. He just looked hot and sweaty. He said he goes thru scrubs all day long

This really opens my eyes to how hard anesthesiologists work and what they have to take into consideration.

I remember when I was going through my military nursing school roughly 18 years ago, I spent some time in a burn unit and that OR was kept quite warm (100F if I remember?) due to how extensive the burns we delt with were (often 80% and more TBSA) and I vaguely remember being told it was due to how unequipped the patients were to regulate their own body temp.

Both surgeries I've had since 2014, they put heated blankets on me once moved to the surgery room. They automatically do this for patients with diabetes, but also patients over the age of 60 (I was in 50s at the time). If you tend to be cold when others are comfortable or hot, be sure to mention this when you are in the pre-surgery prep room.

You might find it interesting to visit a semi-conductor production facility. The standards for removing particulates and exchanging air are many times more rigorous than OR's. In fact, in some parts, there isn't anyone in the facility at all. It's just robots. I worked for a company that had a smoke-enders program in which the technicians participated. The production crashed. It turned out that earlier they had tweaked the process to get the yields they wanted. Now that technicians were not smoking, not exhaling or sweating out the biproducts of the habit, the tweak was now wrong. They untweaked and all was well. This demonstrates just how sensitive the chemistry is. All that was a "Sub micron" facility but now, it's 5 nanometers and - no humans allowed.

I firmly believed it was to freeze out bacteria, viruses and other pathogens. I did have one warm operation, when I had my gastric Bypass at the Ohio State University in Columbus Ohio. My anestheologist actually asked if I was comfortable before I went off to LaLaLand- I knew if He was That Considerate- I was in Pefect Hands!

I once got too much anesthesia when I went for a cornea transplant, that I almost died, and slept like a baby for the next week. The next time the specialist gave me less of the medicine and my surgery was more normal, like the last time I had surgery when I got my inflamed appendix removed. It made me really appreciate those who do your job, so thank you for all the hard work you do for your patients!

When I was a few weeks away from turning 13, I had an accident that resulted in a skull fracture requiring a fairly intensive surgery. I think it was the nurse who said something to either myself or my parents about asking for a warm blanket for my surgery, or maybe it was someone else on the team. I don't remember a whole lot of those 2 weeks that I was in the hospital, but I do remember the discussion of a hot blanket, and when it was actually time for my surgery, the sensation of a heavy, warm something being draped over me as someone told me to start counting back from 100 (and I only remember getting as far as 98) and then I was talking to someone in the recovery room.

It’s freaking freezing in the OR. This is really interesting

Okay, I watched this from beginning to end. I hope you keep an affiliation with a hospital that trains doctors and nurses. You have an enormous aptitude for keeping the material interesting and engaging. I've had three 'procedures' so far and while it was just an idle curiosity why the room was so cold now I at least understand some of the reasons why. Thank you very much!

Just finished OR rotation as a nursing student. I loved how it was always cold. And yes, I agree that the surgeons love it cold. It happened to me twice where the surgeon complained that it was hot. They had to lower the thermostat.

Matt's video series on general anethesia was a huge help for me. Had surgery shortly after watching these and I was significantly less anxious & stressd out because I knew what the anesthesiologist would be doing, in what order & why they were doing each part of the procedure. I can''t thak you enough for making this series. Great job. 👍

For a pulmonary endarterectomy the patient`s body temperature needs to be at around 18°C. Therefore, the warming blanket is actually used to cool the patient down, the heart-lung-machine cools the patient`s blood but also the room temperature is lowered even more. In my opinion it gets really cold in the OR during this specific procedure. Thats why i like to wear scrubs with long sleeves for a PEA.

You are truly impacting a lot of youngsters in Aneasthesia school. Thank you.

We kept our recovery room pretty cool after I gave birth and the doc actually told us we had to turn it up cause it could’ve been contributing to our newborn daughter not gaining weight quick enough. Like her body was working to keep her warm and in turn burning calories. She never shivered or anything and the nurse turned the temp down, not us lol. It was just interesting!

Before a recent surgery I actually had one of the nurses tell me exactly this. I appreciated the honesty.

Thank you for your videos, I’ll be having my 10th surgery tomorrow thanks to my autoimmune disease. No matter how many times I’ve been through it, anesthesia still makes me nervous every time. But watching your videos really humanizes it and makes it less nerve wracking. Thank you! 😊

We had a Bair Hugger in the infirmary at the ski hill I patrolled at to help warm up patients we brought in on cold days. It was a great addition to the kit.

I have been in recovery and freezing but couldn’t tell any one because I wasn’t totally awake yet. Finally shivering violently I was able to speak and ask for a warm blanket! Thank you for discussing this very important aspect of surgery!

I just discovered your channel and can't wait to watch all the videos. My name is Ted and I retired 6 years ago from a 42 year career in nurse anesthesia. I feel so blessed to be doing something that I loved and I still miss the hustle and bustle to this day but at 73 years old the memories will do. I can remember the banter between the surgeon and OR staff complaining about the room temperature. I wore a long sleeve undershirt under my scrubs and a disposable surgical gown over top. Occasionally we could swipe an extra bair hugger from across the hall and put the nozzle under our gowns. Could you speak on the topic of loud music in the OR. Some younger surgeons insisted on blaring their tunes all the while the staff and I could barely hear the monitor alarms and the loud noise can be detrimental to the thought process. No kidding, I've had arguments when asking to turn the music down so I would just call my chief and let those two go at it. Thanks , I will subscribe . Ted in Sebastian, Florida

OMG after several procedures in freezing ORs, the latest one they finally gave me the heater in the recovery room. I’m really sensitive to cold & drafts & this was like heaven. Thanks for explaining.

These videos were a RU-vid rabbit hole recommendation. And I must say, Dr. Feinstein is such a reassuring voice and I admire his temperament. And when (if) the day comes for me to have surgery, I hope that someone quite similar and just as competent is “at the controls” and safeguarding my life in the OR.

I had spinal surgery last year. First time i'd been in hospital for an operation since i was five. I was surprised at just how cool the operating theatre was when i got there. Have to give a shout out to the Anesthesiologist i had though. He was wonderfully calm and reassuring as i was going through the process of it. Really settled any nerves i had.

Mad respect for answering the question at the beginning, then giving more information if we are still interested.

I had a major spine surgery done three weeks ago. I was told that it was 11 hours and required two units of blood. I remember being wheeled into the room but since I’m more hot natured the cool temperature didn’t bother me. The anesthesiologist was surprised that I wasn’t using the hugger blanket and more surprised when I declined the offer of warm blankets. We had met earlier in pre-op but he asked questions about me being more comfortable when cooler as that hadn’t come up previously. He said that he would keep me comfortable and safe during the procedure which was complicated by three position changes. Your videos really help me to understand how important your role is in the operation. He also assured me that he would never leave my side. I’m not sure how practical that is given the need for bathroom breaks but I appreciate the sentiment.

I also believed it was to reduce bacteria. I wonder where these ideas start? I’ve had 14 operations in my life and I must say the most important person in the operating room is you! When I have my pre-op chat with the anesthesiologist, I tell them so ! ❤

I was in an outpatient facility yesterday for a knee replacement and the place was cold. But when the anesthesiologist did his thing, I was out and never knew the temp. Everything Max presented makes sense. Good video

My mum had surgery on Monday of this week to remove a rare (but thankfully not aggressive) tumor from her stomach. It was planned as laparoscopic, but ended up being open surgery once they had started operating because they needed to go more hands on to find the tumor. They managed to remove the entire tumor and some tissue around it to really ensure that it was all gone and mum is now considered cured! We were also expecting her to need to be in hospital until the weekend but I actually picked her up and brought her home already yesterday, and she could have been discharged already on Wednesday from a medical point of view, the reason she came home yesterday was because I need to know about such long drives beforehand (the hospital is almost 50 miles away) as I’m disabled and deal with severe chronic pain, so longer drives and longer excursions from home is something I need to plan ahead a bit and ensure I’m well rested. The extra night in the hospital for mum also gave her a bit more time to ensure she was indeed ready to go home and also gave us a bit of peace of mind to have her heal a little bit more before getting in and out of the car and such. Mum had an absolutely amazing team caring for her both during surgery and at the ward! She didn’t mention feeling cold so I’m guessing she had plenty of cozy blankets on her before being put under. Anytime I’ve been in an operating room, I’ve always needed a ton of blankets because I’m actually shivering in there, I feel cold very easily, and I always mention to the team working on me that “it’s amazing you can work in this, it feels like we’re in Antarctica” XD

Enlightening. I as a CBET, I would suggest discussing with a Biomed about troubleshooting some of the common issues with OR equipment. Items like Gas Machine circuit test issues, infusion pump problems, etc.

Unless I missed it, one reason wasn’t mentioned. I’m a nurse and I worked outpatient surgery, we always kept the temp at around 66 degrees. One day our air conditioning was not working and temps were rising. We were notified that if it wasn’t fixed we were going to have to cancel the rest of the cases for the day. The reason being that our equipment needs those temps in the 60’s in order to function, and that is what I would tell my patients when they complained about the cold.

Thank you for answering a question I didn't know I had. Now, I'm off to check out more of your informational videos. So glad I stumbled across your content. Thanks again!

Hi Max, Thanks for answering that one! I am an AV consultant and in my first business, videotaped some Orthopaedic procedures in Melbourne Australia in the 80s. A specialist in Melbourne had developed a novel, faster procedure for hip replacement and Howse Protheses, owned by Johnson and Johnson, came back afterwards and said that this was the best quality video of a procedure that they have ever commissioned. I used a high quality camera, studio lighting and the camera was positioned over the operating table the night before the procedure by a Grip from the film industry. They were so happy that they got the Surgeon and us to do two more procedures. I was fascinated by everything in the Operating Theatre. In the last few years I have had two emergency procedures (a terrible triad elbow and a quads tendon rupture) as well as two prostate biopsies. And now to my point. The Anaesthetist usually appears before the procedure, introduces themself and a bit later, either they or an Anaesthetist Nurse, put you to sleep before entering the OT and then they hold your life in their hands - sometimes literally! Generally, you never see them again. So do they/you go into this important speciality to avoid patient contact? BTW - before the last biopsy, I asked the Anaesthetist if I could stay conscious unit after I had been wheeled into Theatre so that I could see everything. He agreed! Max - keep the vids coming, I enjoy really enjoy them.

I would appreciate your insights on the pediatric patient experiencing hypothermia during extended procedures. I enjoy your familiar humor I witnessed as an OR tech back in my days. Blessings to you!

I wondered the same thing when I had my first surgical procedure (pacemaker). It was almost like being on a different planet. All went well, the staff was great, and the surgeon complimented me about how cooperative I was. I neglected to tell him that he was the one wielding the scalpel...

When I was rolled into the O.R. for my first surgery ever, I wondeed why it was, so cold in there... you explained it in a most excellent way. Thank you!

Thanks Dr M. Feinstein for all the thorough and less mysterious explanations about Anesthesia, Meds, OR, Temperatures, etc, etc.

It's interesting to hear an explanation on the human medicine side of things. I perform anesthesia in veterinary medicine. We always hear about human medicine being vastly more advanced with research/technology and whatnot but it's comforting to know most of my job is pretty similar to what's mentioned here ☺

Great video Doc! You teach us so much!

This explains to me everything that transpired when I hit the cold OR table. Thanks!

Awesome video! When you said the most important person in the OR, I immediately thought Surgeon, closely followed by anesthesiologist. You are so correct! It is the patient. For my last surgery(outpatient) I was wrapped in the Hair Hugger. I was still cold the entire time. They kept trying to make it warmer, but I was uncomfortably cold. By the time I hit the OR, I was too out of it to care about the temp in the OR, but I did notice it was very cold, like previous surgeries. Very cool video! Thanks.

Thanks, enjoyed that more in depth explanation. I actually did know that but only because I asked an OR nurse as I was being wheeled in once! Cheers from Western Australia

Hi Max, Thank You for another EXCELLENT video. I am not in the medical profession but enjoy learning about anesthesiology💖

The lead really seals in the juices. Sometimes we come out drenched in sweat. Great for giving hugs!

Hi Max, thanks for your videos, they are invaluable. I’m an ICU nurse who cares for patients after very long, complex operations. I’d love to know the effects of anaesthesia/drugs on the body after hours of surgery. A recent young exenteration patient had a lot of facial oedema that took a long time to resolve for example. Would be good to know from a nursing perspective.

Doctor F is the man. He is the person I want on my care team full stop. Thank you Doc for all these nuggets of wisdom and humor.

I have worked at my hospital for 22 years. Some years ago a new wing was almost finished that would create a new main entrance with the standard foyer with two sets of doors and it was very cold in between, in the foyer. I had the occasion to ask the architect about the cold air in the foyer. He explained that it was a "flying insect barrier" to help prevent disease transmission.

Thank you for this explanation. In 2002, I had to have an emergency appendectomy. I noticed how cold the operating room was for the minute or 2 I was in it before I was knocked out; the table they made me move myself onto was cold, too! 🥶 But about 2 minutes later, I was waking up in my hospital bed in my room. I wish they’d used something like the Bair Hugger on me then.

I've been a Theatre RN for 30yrs & am so used to being cool, theatre garb, concentration & the light keep me awake. Thanks for your video.

Huh 😮very 🥶interesting…I love your humility, you must be very easy to work and get along with. 🤗

thank you for the explanation doc, I used to shiver during a cesarean section. my head and hands were shaking. the nurse had wrapped me in a blanket, but I was still cold. The anesthesiologist finally turned up the room temperature, but I was still shaking. The Obgyn doctor during the operation protested why the room was so hot.

Great video man! I learned a lot! Great info! I really enjoyed donating to the anesthesiologist Foundation, since it was hard for me to go to college to be a anesthesiologist after I graduated high school in 08 because of my cerebral palsy! I think it takes special people to be a anesthesiologist, and you’re one of those special people, I’m one of those special people too!! I love anesthesiology! Anesthesiology is the best

I'm really surprised people think the cold stops infection lol. also it's fascinating how anesthesia impacts heat retention in the body. great video!

Retired R.N. here: This video is amazing. Well presented as is your usual.

You explained it so simply in your videos! Love your videos!

I always thought that it was to control bleeding. Thank you for another informative video Max.

Yes, you’re right it keeps the surgeon and surgical tech cool, but it has a more important role. It helps to keep the humidity down as well. Humidity/condensation can present a problem with maintaining a sterile field. Also, you don’t want a surgeon sweating his eyebrow over an open patient.

Hi Max, My name is John. Just retired after 40 yrs as a surgical first assistant. Agree totally with your assessment of Temp in the OR. As a scrubbed team member, I'm more on the side of anesthesia than surgeons. lol. Froze many a day. hey good luck with your career, stay warm.

I wondered about the cold OR temperatures! That’s why the warm blanket is my favorite part when I have surgery.

So I'm an neuro IR tech and we were coiling an unstable cerebral aneurysm and our biplane angio table overheated and shut down WHILE THE INTERVENTIONALIST WAS ABOUT TO DEPLOY A COIL. I will never EVER forget that case. The room was unusually warm but not enough to warrant it as unusable. The scrub team wearing 12-15 lbs of lead plus surgical gowns....well we were super uncomfortable but this case was an emergency. So what happened to the patient? We kept them intubated, secured the sheath in the groin, transferred them to another room, moved all of the anesthesia equipment all the while the interventionalist was pacing back and forth (still impressed he kept his composure) Horrific situation I will never ever forget and I will never raise the temp of my room I don't care how damn cold the staff is. And for the patient there are bair huggers for a reason. The coiling went great by the way. And this was at a top ten hospital

Hi Max, thanks for this great video about temperatures in operating room. I imagine that while the pandemic was going on, the amount of material and protections surgeons wore was even more. I would also think that a surgeons adrenaline is quite high so that also would make them warmer as well. Your channel is so helpful to lay people, that want more information about being an Anesthesiologist and it's challenges.

Thanks for sharing your knowledge with the public Dr. Max.

Just want to say thank you for educating us and I absolutely love your little patterned hat. (Hospitals are sort of intimidating, and this is a sign that you are an approachable person, plus it lets a little bit of your personality shine. 💕) Looking at thumbnails you have more than one. Subscribed. 😊

If you feel uncomfortably warm in an adult OR, go to a paediatric one. Those can be well above anaesthetist temperatures

Love you caps. I can understand wanting cooler air.

Max thank you for the job you do. You are a great humanitarian. God Bless you and the teams you work with.👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍

Your channel is very educational but also fascinating

Heh. In my last surgery, I was actually kept awake, which was novel - the anesthesiologist let me have input in my level of sedation - and one of the first conversations we had was over what temperature we were going to keep me, because my body temperature is generally about a degree cooler than "standard" (I'm sure you're aware of the variability of body temperature). It was kind of funny to have a nurse bringing up my EPIC EHR to verify that yeah no, I generally run cold, so please don't make me uncomfortably warm!

We have like 20 to 20.5°C in the German ORs I'm at and it's a happy medium where I feel pretty comfy working at the table as well as sitting around 🤷‍♂️

The OR I was in last month for heart surgery felt more like 15 C. When I mentioned it my anesthesiologist agreed and everyone laughed. Didn't get the laughter at the time but I do now. Thank you for the interesting and informative videos.

I’ve had 15 surgeries with ET general anesthesia. As I also have several AU, and am ‘old’ 68 for my last surgery, don’t do well with cold or hot. (Also am a 40 year nurse and have been on the other side of that ‘bed’ during surgeries. So can appreciate the temp layered up and moving.) Surely enjoy your videos. Keep them coming!

I work in a hospital…. A secretary… and I always believed it was because germs don’t like the cold…. Very interesting and thank you so much for sharing😊

I had a good few orthopedic surgeries after a serious car crash because doctors couldn’t fix me at first time and they needed to break a bone to redo surgery. I am a type of woman which loves warmth and heat (cold feet and hands) and every time I woke up from general anesthesia I always shivered and was shaking uncontrollably. I love watching your videos as I like to get to know some interesting facts about medicine and biology/anatomy.

Thank u for your videos I have learned so much from your videos as I was in and out of hospitals for 5 years oh, yes I remember that noise and so cold my body looked like I was having a seizure-got them all freaked out. Those operating rooms r way to cold I always called them the ice room. I remember they had to put multiple blankets on me to get me warm. I found it odd the last major surgery I had while recovering in a room they turn the heat down so much I layed in bed so cold and they told me they keep the rooms cool to kill bacteria-I didn't buy it, I was always asking for blankets finally 1 nurse just turn the heat up. When I got home in my warm environment I came down with a nasty cold. Thank u for making these videos I learn so much from u have a great day, stay safe and keep making videos

Haha the heated pun was amazing. In all seriousness, Thank you for all you do! Lots of love to all ❤️

It would have been an interesting addition to the video to discuss what sort of clothes you are allowed and not allowed to wear in the OR if you want to make yourself more comfortable.

I actually had a series of major operations at Mount Sinai in 2012 and I asked the anesthesiologist right before one of them, why the ORs are always so freezing cold. I thought it might have something to do with whatever the reason is, that MRI rooms are also always freezing. But he told me the same thing that was said in this video. I forget what the reason is that MRI rooms are always so cold too, but it's completely different. I was kind of surprised he actually bothered to answer my question when he knew I was going to be out in literally another two seconds. I didn't think the reason might be to control infections, like some people think. I would think if they wanted to control infections, they'd have to actually make the room way colder, like at least the temperature of a walk in refrigerator or freezer. And that low of a temperature, you'd have frostbite to contend with. I did always wonder how to lower temperature and exposure to air to, affects a person's insides, though.

Thank you for the clarification. Coming out of chiropractic school, I had the opportunity to shadow some orthopaedic surgeries and found one of those surgeries to be particularly cold. The anesthesiologist must have noticed me shivering and grabbed me a heated blanket. I’ve always wondered why

I had squamous cell cancer removed from the palm of my left hand. The cancer covered half of my palm. Had Mohs surgery on 12-29-22, and then went to plastic surgery for closure. In post op I was given a Bair hugger to keep warm. Worked wonderfully,.better than heated blankets.. My core temp is about 96 even on a hot day. Very good video.

A few weeks ago I was diagnosed with a pheochromocytoma. I've read that they are sometimes called "an anesthesiologist's worst nightmare" in the context of an unknown one discovered during abdominal surgery for an unrelated reason. Fortunately, mine was caught when we found an adrenal tumor while getting a chest CT for unrelated reasons, so I know surgery won't be nearly as dangerous for me. My understanding, though, is that it is kind of a capital B, capital D Big Deal surgery. Especially as it pertains to anesthesiology. Can you tell us more about that? Are there other rare conditions those pose a similar degree of threat if you just happen upon them? And as a complete aside, when I saw my neurologist the other day and I told him about the pheo (the clinician who diagnosed me isn't in Epic so he didn't immediately see it in my chart) he said, "Wow. We all learn about these in med school but almost no one will ever see one." Do you feel like that rings true? I

And the circulating nurse prefers 68 degrees F- we split the difference! For major abdominal surgeries with large exposure, I’ve used both upper and lower Bair huggers to warm as much of the patient as possible. Also tried to get the surgeon a cooling vest/ unit if one was available. Sweat dripping into the field is not good for infections either We also tend to have fainting med students when the room is too hot- circulator must tend to them as well.

Extremely informative. Thanks so much!!!

Thanks for the education. The few times I have been in surgery the room seemed really cold but I figured it wouldn't bother me much after I was asleep.

Once when I was assisting with LSCS as a intern in the OR and i remember the AC weren't working that day (at night 3am), the heat from the scrubs and the OR lights made me feel intensely hot and this churning sensation in the stomach and i almost fainted. That made me realise why I would never become a surgeon 😂

Great video and explanation - very helpful, thank you.

Waking up afterwards I’ve noticed the surgeons hands are freezing I appreciate you all honesty..you all do great work ❤

I'm an anaesthesia resident in Germany and I'd always wondered about this before starting my residency. On a lighter note, the best part of the video is that you used Celsius instead of Fahrenheit. Lol

thank you for debunking the myths of the cold temp in the operating rooms.. now i can sympathise with how the surgeons feel while at work

You are super cool and break down complicated medical processes in a way we non-medical people can understand, thanks.

That explains why I have woken up freezing all the times I have been operated! Thanks!!

I’ve only seen a few of your videos (they’re great, can’t wait to learn more!). I’m curious about why the IV meds they give right before going under actually seem to hurt in my vein. It’s happened every time I’ve had general. Surely there’s a way to reduce or eliminate it? Is it something to ask the surgeon about (if there’s no pre-op consult w the anesthesiologist )?

Great video

Ah, Thank you for this information. I am one that thought it was also to keep infections down. Learn something new every day. Take care.

That was the first thing I noticed at the operating room's temperature, but I was hot at the time and the coolness of the room felt great.

As a surgeon, I was sure when you said "The most important person in the rooms at all times is ...", the answer was going to be the anaesthesiologist!

My assumption was actually always that the ORs were cold to keep the surgeons comfortable lol. This might sound silly but I also assumed it was likely more helpful to the patient in some way, so it is interesting to see that the opposite is likely true. I guess I just sleep really well in a cold room and thought it translated. Maybe the surgeons need a cold bair hugger so that the patient and anesthesiologist can be a bit warmer.

This made a lot of sense thank you!