ABA Patient Communication Skills 3 — Questions and Answers
Question 1: A cognitively impaired elderly patient cannot provide consent for an urgent hip fracture repair. The healthcare proxy is unreachable. What is the anesthesiologist's appropriate next step?
- Postpone surgery until the proxy is reached, regardless of urgency
- Proceed under the emergency exception to informed consent after interdisciplinary agreement (Correct answer)
- Obtain consent from the nearest available family member informally
- Document the situation and defer entirely to the surgeon
Correct answer: Proceed under the emergency exception to informed consent after interdisciplinary agreement
The emergency exception allows treatment without consent when delay would cause serious harm and the decision-maker is unavailable, following institutional policy.
Question 2: A patient asks the anesthesiologist what their chances are of 'waking up during surgery.' Which response demonstrates both honesty and effective communication?
- 'That never happens with modern anesthesia, so there is nothing to worry about.'
- 'Awareness under anesthesia occurs in approximately 1–2 per 1,000 cases; we use monitoring and techniques to minimize this risk.' (Correct answer)
- 'I cannot give you statistics; every patient is different.'
- 'That is a question better directed to your surgeon.'
Correct answer: 'Awareness under anesthesia occurs in approximately 1–2 per 1,000 cases; we use monitoring and techniques to minimize this risk.'
Providing accurate incidence data with reassurance about preventive measures addresses patient concern honestly and builds trust.
Question 3: Which non-verbal communication behavior by the anesthesiologist most effectively conveys empathy during the pre-operative interview?
- Standing at the doorway to maintain efficiency
- Making consistent eye contact and using an open, forward-leaning posture (Correct answer)
- Taking extensive notes without looking up to demonstrate thoroughness
- Wearing a surgical mask throughout the interview to maintain sterility
Correct answer: Making consistent eye contact and using an open, forward-leaning posture
Eye contact and open body posture are key non-verbal signals that communicate attentiveness and empathy.
Question 4: A patient expresses fear that anesthesia will cause permanent memory loss. This belief is incorrect. How should the anesthesiologist address this?
- Dismiss the concern as misinformation without elaborating
- Correct the misconception gently, explain realistic postoperative cognitive changes, and invite further questions (Correct answer)
- Agree partly to validate the patient's feelings and avoid conflict
- Refer the patient to online resources without discussion
Correct answer: Correct the misconception gently, explain realistic postoperative cognitive changes, and invite further questions
Correcting misconceptions respectfully, providing accurate information, and welcoming questions supports informed consent and reduces anxiety.
Question 5: When obtaining informed consent from a patient who is a Jehovah's Witness regarding blood transfusion refusal, what must the anesthesiologist ensure?
- Convince the patient to accept blood products before proceeding
- Document the patient's competent, voluntary refusal after ensuring understanding of life-threatening consequences (Correct answer)
- Arrange court intervention to override the refusal
- Proceed with surgery and transfuse if hemodynamically necessary without further discussion
Correct answer: Document the patient's competent, voluntary refusal after ensuring understanding of life-threatening consequences
Competent adults have the right to refuse treatment; the anesthesiologist must document a thorough, voluntary informed refusal process.
Question 6: A parent insists on being present during induction of anesthesia for their 5-year-old child. Which approach reflects best practice in pediatric anesthesia communication?
- Deny the request to maintain OR sterility and workflow
- Evaluate the parent's anxiety level and facilitate parental presence if it benefits the child's cooperation and comfort (Correct answer)
- Allow parental presence only if the surgeon approves
- Require the parent to sign an additional liability waiver before permitting presence
Correct answer: Evaluate the parent's anxiety level and facilitate parental presence if it benefits the child's cooperation and comfort
Parental presence during induction is evidence-based when it reduces pediatric anxiety and the parent is calm; individualized assessment is key.
Question 7: After a procedure, a patient reports that they were not fully informed about the risk of postoperative nausea and vomiting (PONV). What is the primary preventive communication strategy?
- Explain that PONV is unpredictable and therefore cannot be included in standard consent
- Include PONV risk discussion and prophylaxis options as a routine part of the pre-anesthesia consent conversation (Correct answer)
- Rely on the nursing staff to explain PONV during post-operative care
- Document PONV discussion in the chart retroactively
Correct answer: Include PONV risk discussion and prophylaxis options as a routine part of the pre-anesthesia consent conversation
PONV is a common, manageable complication that must be discussed proactively in pre-anesthesia consent as part of routine informed consent.
ABA Patient Communication Skills 3
A cognitively impaired elderly patient cannot provide consent for an urgent hip fracture repair.
The healthcare proxy is unreachable.
What is the anesthesiologist's appropriate next step?