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Introduction
CHAPTER 3 Preoperative
Evaluation, Patient Preparation, and Informed Consent
Dori Goldberg Amanda Auerbach James Bota Mary E. Maloney
SUMMARY
Preoperative preparation should include a discussion regarding the procedure; a
review of the patientโs history, medications, and allergies; any appropriate physical examination; obtaining informed consent through a process; and answering patient and/or family questions.
The preoperative evaluation ultimately serves as a forum to assess probability
of overall success and cement the patientโphysician relationship.
Beginner Pearls
From the first moment the patient steps into the office, the front office staff has the
opportunity to begin collecting information, such as the patientโs mood and degree of anxiety.
If capacity is ever in question, simple questions like โwhere do you live?โ or โhow
did you get here?โ are innocuous queries that evaluate mental status without prompting any perceived stigmatization.
Expert Pearls
Outline postoperative restrictions ahead of the procedure so that patients avoid
conflicts with athletic events as well as allowing them to make any arrangements they may need for home care, child care, time off from work, or transportation to and from the procedure.
Patient preparation and the informed consent process is a critical part of the surgical
procedure.
Donโt Forget!
While a written signature is desirable, the real goal of the consent process is effective
communication.
If an informational packet is provided to help patients prepare, it may include an
outline helping them prepare for the pre- and postoperative period.
Pitfalls and Cautions
Patients who have many questions or voice cosmetic concerns when they are
scheduling their procedure are self-identifying as individuals who would benefit from an in-office preoperative consultation.
Patient Education Points
Without adequate preparation, even mild and expected outcomes, such as edema and
ecchymoses, can be a cause for significant concern.
Make the patient your partner, and use partnering language when discussing the
surgical plan.
Certain subtleties become evident over time, such as personality, forgetfulness,
unrealistic expectations, or specific fears that can be noted by the staff and guide the remainder of the visit. These observations can be acted upon early and preemptively, helping to tailor the patient care experience in a positive fashion.
Some patients under 18 may look older than they are (and vice versa), so it is
important when operating on young adults to check their date of birth.
A full discussion of benefits and risks improves mutual trust and respect between the
physician and patient, and ultimately improves patient satisfaction.
CHAPTER 3 Preoperative