ABFAS Patient Communication Skills 3 — Questions and Answers
Question 1: A patient asks why the surgeon recommends a total ankle replacement instead of ankle fusion. The patient read online that fusion has better long-term outcomes. What is the ideal response?
- Discourage online research and explain that the surgeon's recommendation is most reliable
- Acknowledge the patient's research, discuss the evidence for both options, and tailor the recommendation to the patient's specific situation (Correct answer)
- Defer the decision entirely to the patient since they have done their own research
- Order additional imaging to justify the recommendation before responding
Correct answer: Acknowledge the patient's research, discuss the evidence for both options, and tailor the recommendation to the patient's specific situation
Acknowledging patient research and engaging in a shared discussion about evidence supports informed decision-making and the therapeutic relationship.
Question 2: Prior to a calcaneal osteotomy, a patient asks about the surgeon's personal complication rate. What is the best response?
- Decline to answer as personal outcome data is confidential and proprietary
- Provide published literature complication rates and deflect the personal question
- Share your personal outcome data honestly and place it in context with published benchmarks (Correct answer)
- Tell the patient complications are rare and that they should not be concerned
Correct answer: Share your personal outcome data honestly and place it in context with published benchmarks
Transparency about personal outcomes, placed in appropriate context, is an ethical obligation and strengthens the trust required for informed consent.
Question 3: A patient appears visibly distressed after receiving the diagnosis of Charcot neuroarthropathy. Which communication technique is most appropriate at this moment?
- Immediately provide a detailed treatment plan to give the patient a sense of direction
- Allow a moment of silence, acknowledge the patient's emotional reaction, and ask if they want to continue the discussion (Correct answer)
- Minimize the severity to reduce patient anxiety before discussing management
- Hand the patient educational materials and schedule a follow-up to discuss the diagnosis
Correct answer: Allow a moment of silence, acknowledge the patient's emotional reaction, and ask if they want to continue the discussion
Pausing to acknowledge emotional distress before proceeding with clinical information demonstrates empathy and allows the patient to process the diagnosis.
Question 4: During a pre-operative discussion, a surgeon uses terms such as 'dorsiflexory wedge osteotomy' and 'peroneal spastic flatfoot.' The patient nods throughout. What should the surgeon do?
- Assume comprehension since the patient did not ask any questions
- Ask the patient to explain the planned procedure in their own words to confirm understanding (Correct answer)
- Provide a written copy of the operative note template for the patient to review
- Use a medical dictionary to help define any terms the patient may not understand
Correct answer: Ask the patient to explain the planned procedure in their own words to confirm understanding
Using teach-back confirms actual comprehension, since nodding or silence does not reliably indicate understanding of technical medical terminology.
Question 5: A parent brings their 16-year-old for evaluation of a bunion and insists on discussing diagnosis and treatment without the teenager present. What is the most appropriate approach?
- Discuss only with the parent since the patient is a minor
- Examine and counsel the adolescent patient directly, then include the parent in a summary discussion (Correct answer)
- Defer to the parent's wishes entirely to maintain a cooperative relationship with the family
- Refer the case to another provider to avoid the conflict
Correct answer: Examine and counsel the adolescent patient directly, then include the parent in a summary discussion
Adolescents should be engaged directly in their care; while parental involvement is appropriate, the patient's autonomy and understanding must be fostered.
Question 6: A patient with a history of chronic pain syndrome reports that postoperative pain is far worse than anticipated after a flatfoot reconstruction. The patient is upset and feels their concerns were dismissed. What is the priority response?
- Order imaging to rule out a surgical complication before engaging with the patient's concerns
- Apologize for the distress, validate the patient's experience, review pain expectations, and discuss a management plan (Correct answer)
- Refer the patient to pain management immediately to avoid further conflict
- Document that the patient was counseled preoperatively about expected postoperative pain
Correct answer: Apologize for the distress, validate the patient's experience, review pain expectations, and discuss a management plan
Validating the patient's pain experience and engaging collaboratively in a revised management plan addresses both the clinical and relational dimensions of the problem.
Question 7: A surgeon leaves a voicemail informing a patient that their biopsy result showed a benign lesion. The patient later states they never received the message. What is the most appropriate process improvement?
- Have the patient sign a form acknowledging they are responsible for retrieving messages
- Implement a closed-loop communication protocol requiring documented patient acknowledgment of all result communications (Correct answer)
- Use email as the primary method for delivering biopsy results going forward
- Leave a second voicemail and document the date and time in the medical record
Correct answer: Implement a closed-loop communication protocol requiring documented patient acknowledgment of all result communications
Closed-loop communication protocols ensure results are received and understood, reducing the risk of patients missing critical clinical information.
ABFAS Patient Communication Skills 3
A patient asks why the surgeon recommends a total ankle replacement instead of ankle fusion.
The patient read online that fusion has better long-term outcomes.
What is the ideal response?