General Surgery Board Review Communication & Stakeholder Relations 3 — Questions and Answers
Question 1: A patient scheduled for elective hernia repair asks the surgeon to guarantee the procedure will be successful. The most appropriate response is to:
- Provide the guarantee to reassure the patient and improve compliance
- Explain that outcomes cannot be guaranteed but share realistic success rates (Correct answer)
- Refer the patient to another surgeon if they require guarantees
- Postpone consent until the patient's expectations are more realistic
Correct answer: Explain that outcomes cannot be guaranteed but share realistic success rates
Surgeons must never guarantee outcomes; sharing evidence-based success rates and risks constitutes honest, appropriate expectation-setting.
Question 2: During a multidisciplinary tumor board meeting, a radiologist and surgeon disagree about the resectability of a pancreatic mass. The optimal approach to resolve this conflict is to:
- Allow the surgeon to make the final decision as the treating physician
- Review the imaging together and seek additional specialist input if needed (Correct answer)
- Defer to the most senior physician present
- Schedule a repeat scan to avoid the conflict
Correct answer: Review the imaging together and seek additional specialist input if needed
Collaborative review of evidence and seeking additional expert input ensures patient-centered decision-making and resolves clinical disagreements constructively.
Question 3: A surgeon must disclose a retained surgical sponge discovered on postoperative imaging. Which communication strategy is most appropriate?
- Notify risk management first and let them communicate with the patient
- Meet with the patient and family promptly, disclose the event honestly, and outline next steps (Correct answer)
- Await legal counsel before saying anything to the patient
- Document the finding and schedule a routine follow-up appointment
Correct answer: Meet with the patient and family promptly, disclose the event honestly, and outline next steps
Prompt, honest disclosure of serious adverse events is ethically mandatory and is required by most accreditation standards, including The Joint Commission.
Question 4: A patient in the surgical ICU lacks decision-making capacity. No advance directive exists, and both a spouse and an adult child disagree about continuing aggressive care. The most appropriate step is to:
- Defer to the spouse as the default legal next-of-kin
- Convene a family meeting facilitated by the palliative care or ethics team (Correct answer)
- Continue current treatment until legal guidance is obtained
- Allow the surgeon to make the unilateral decision to avoid conflict
Correct answer: Convene a family meeting facilitated by the palliative care or ethics team
Ethics consultation and facilitated family meetings help resolve surrogate disagreements while centering the patient's best interests.
Question 5: A nurse reports to the surgical resident that a patient is expressing suicidal ideation postoperatively. The resident's first action should be to:
- Document the report and plan to assess the patient during morning rounds
- Perform an immediate bedside assessment and activate the psychiatric consult pathway (Correct answer)
- Notify the charge nurse to monitor the patient closely
- Reassure the nurse that postoperative depression is common
Correct answer: Perform an immediate bedside assessment and activate the psychiatric consult pathway
Suicidal ideation requires immediate assessment and psychiatric involvement; delay risks patient harm and constitutes a failure of duty of care.
Question 6: A patient declines a blood transfusion for religious reasons despite a hemoglobin of 6.5 g/dL following major abdominal surgery. The surgeon should:
- Obtain a court order to override the patient's wishes
- Respect the refusal, document it, and optimize non-transfusion hemostatic measures (Correct answer)
- Transfer care to another surgeon who will proceed with transfusion
- Administer blood covertly to prevent harm
Correct answer: Respect the refusal, document it, and optimize non-transfusion hemostatic measures
Competent adults have the absolute right to refuse medical treatment, including transfusions; surgeons must respect this and pursue alternatives.
Question 7: Before performing a procedure at the bedside, what element of the WHO Surgical Safety Checklist is relevant even in non-OR settings?
- Anesthesia equipment check
- Patient identity, procedure, and site verification (Correct answer)
- Antibiotic prophylaxis administration
- Count of surgical instruments
Correct answer: Patient identity, procedure, and site verification
Verification of patient identity, the planned procedure, and the correct site is the core safety step applicable in all procedural settings.
General Surgery Board Review Communication & Stakeholder Relations 3
A patient scheduled for elective hernia repair asks the surgeon to guarantee the procedure will be successful.
The most appropriate response is to: