General Surgery Board Review Communication & Stakeholder Relations 5 — Questions and Answers
Question 1: A surgeon is aware that a colleague has been operating under the influence of alcohol. The most appropriate immediate action is to:
- Monitor the situation privately before escalating
- Report the concern immediately to the department chief or designated authority (Correct answer)
- Confront the colleague directly in the OR
- Advise OR nurses to watch the colleague more closely
Correct answer: Report the concern immediately to the department chief or designated authority
Impairment that endangers patient safety requires immediate reporting to the appropriate authority; delay constitutes a breach of professional duty.
Question 2: A patient's primary care physician calls asking for a detailed update on a surgical consult without a signed release on file. The appropriate response is to:
- Share full details as a professional courtesy
- Confirm only that the patient is under your care and request a signed release (Correct answer)
- Decline to confirm whether the patient is known to your practice
- Share a summary limited to the primary diagnosis
Correct answer: Confirm only that the patient is under your care and request a signed release
Even treatment-team communications require appropriate authorization; confirming care relationship while requesting a release balances continuity and privacy requirements.
Question 3: During informed consent for a high-risk hepatic resection, the patient asks 'what would you do if you were in my position?' The most appropriate response is to:
- Deflect by saying personal opinions are inappropriate
- Share your personal perspective while making clear the decision ultimately belongs to the patient (Correct answer)
- Provide statistical data only and avoid personal statements
- Defer the question to the referring physician
Correct answer: Share your personal perspective while making clear the decision ultimately belongs to the patient
Sharing a personal professional perspective when sincerely asked is ethically appropriate and builds trust, provided patient autonomy is clearly preserved.
Question 4: A surgical team member raises a safety concern using a 'two-challenge rule' before skin incision, but the surgeon dismisses it. The next appropriate step for the team member is to:
- Comply with the surgeon's direction and proceed
- Escalate the concern to the OR charge nurse or supervisor (Correct answer)
- Walk out of the operating room immediately
- Document the dismissal and proceed without further action
Correct answer: Escalate the concern to the OR charge nurse or supervisor
The two-challenge rule empowers any team member to escalate to supervisory authority when safety concerns are dismissed, supporting a just safety culture.
Question 5: A patient undergoing surgery for a perforated ulcer loses capacity intraoperatively due to hemodynamic instability. The surgeon discovers a synchronous cecal mass. The ethically appropriate intraoperative decision is to:
- Resect the cecal mass immediately to spare the patient a second surgery
- Address the life-threatening perforation only and defer elective resection for informed consent (Correct answer)
- Contact the family by phone for consent before proceeding
- Place a note in the chart and resect the mass at the same operation
Correct answer: Address the life-threatening perforation only and defer elective resection for informed consent
Emergency doctrine allows only life-saving interventions when a patient lacks capacity; an incidental elective finding does not meet the threshold for unconsented surgery.
Question 6: A media outlet contacts the hospital requesting comment on a high-profile patient's surgical outcome. The surgeon's correct response is to:
- Provide a brief statement confirming the patient is doing well
- Decline all comment and direct inquiries to the hospital's public affairs office (Correct answer)
- Confirm the patient's identity but decline clinical details
- Provide a written statement to show transparency
Correct answer: Decline all comment and direct inquiries to the hospital's public affairs office
All media inquiries regarding patients must be handled by the designated public affairs or communications office; any surgeon comment risks HIPAA violation.
Question 7: A patient expresses hesitancy about consenting to a recommended sigmoid colectomy and says they want to 'do more research online.' The surgeon's best response is to:
- Urge the patient to consent quickly to avoid disease progression
- Acknowledge the desire to research, provide reputable resources, and schedule a follow-up discussion (Correct answer)
- Warn the patient that delay is medically negligent on their part
- Document refusal and discharge the patient from care
Correct answer: Acknowledge the desire to research, provide reputable resources, and schedule a follow-up discussion
Respecting patient autonomy includes supporting informed deliberation; providing reliable resources and a return appointment honors the patient's right to decide without coercion.
General Surgery Board Review Communication & Stakeholder Relations 5
A surgeon is aware that a colleague has been operating under the influence of alcohol.
The most appropriate immediate action is to: