The tone of The Scalpel and the Silver Bear combines Alvord's concern for patients with her love of Navajo culture and her tendency towards anxiety and stress. Many of the chapters show Alvord's concern for her patients, particularly the Navajo ones. Several chapters are built around a single character or family, all of whom are used to illustrate some important theme of the book. The tone associated with these patients is one of deep concern, worry and profound respect. Even when Alvord describes patients who are obviously being difficult and make decisions on irrational bases, she speaks kindly and respectively.