1. Discuss the patient’s perceptions of past surgical experiences.
The goal here is to illuminate psychological and emotional residuals (both positive and negative) that might still linger from those experiences. Did all go smoothly and as expected? Were there aspects that were uncomfortable, frustrating, angering or anxiety-arousing? What views of surgery—trust or fear—did past experiences create for the patient?
2. Discuss the patient’s view of others’ experiences with the same or similar procedures.
What has the patient heard from friends or relatives about the pending surgery? Are these stories exaggerated, especially in a negative way? The plethora of television medical dramas, social media commentary and internet (mis)information can influence a patient’s perception of their situation.
3. Discuss the patient’s understanding of their condition and need for the procedure.
The patient should have a substantial understanding of their condition, how the surgery will affect their condition and, consequently, a positive acceptance (if not enthusiasm) of the surgery. The reality is that patients do not always fully comprehend, or may be confused about, aspects of their
condition and care.
4. Discuss the patient’s understanding of the procedure itself.
This is where you want the patient to tell you what they understand about their situation. What you told them is crucial, but what they heard, retained and understand is essential.
5. Discuss the patient’s short-term expectations.
Explore what the patient understands will happen going into the procedure, immediately after and in the ensuing 24 to 48 hours. Is there a realistic expectation of hospital length of stay, pain levels and fatigue? Discussion of postoperative sensations, such as stitches pulling, itching, numbness or
oozing can be valuable. When these events occur unexpectedly, there is a tendency to interpret them in a negative manner (“my wound is tearing open!”).
6. Discuss the patient’s long-term expectations.
Ultimately, you want to hear that the patient has an accurate and reasonable expectation of time and any postoperative rehabilitation that is required. You want to listen for their understanding of what the procedure will accomplish and perhaps what it will not. Unrealistic expectations lead to a difficult postoperative course, strained interactions, disappointment and anger.