"Dr. Sam," a good-natured general surgeon in our same-day surgery clinic, enjoys chatting with patients before procedures. To put them at ease, he regales them with humorous stories, and most of them love it. Last week, Dr. Sam told several of his favorite stories to a patient who was clearly anxious. After he left, she confided to me that she was still dreading surgery. "I had some questions that I never got to ask because he was too busy being a comedian," she said.

Is this surgeon violating his patients' right to be heard or right of full disclosure, which is part of informed consent?-G.P., NEV.

Figure. No caption available.

I suspect "Dr. Sam" doesn't intend to violate patient rights-he's just oblivious to them. Sounds as if he's a little anxious himself-not about his surgical skills, but about his ability to communicate with patients. If the best defense is a good offense, Dr. Sam may be using his presurgery patter to mask his discomfort at dealing directly with a patient who's worried or anxious.

You can advocate for your patients by helping them to ask their questions. As you welcome patients to the same-day surgery area, give them a pen and pad of paper and invite them to jot down their questions so they'll be ready for Dr. Sam when he talks with them before surgery.

All patients should receive a written copy of their patient rights when they're admitted, but many are simply too stressed at the time to read it through. So take a minute to alert them about these rights and explain that both you and Dr. Sam are there to help answer their questions.

If, as in this case, a patient has questions or doubts at any point before surgery, follow up with the surgeon to make sure he addresses her concerns before proceeding. Even though the patient has signed an informed consent form, this is an important element of informed consent. Remember, informed consent is an ongoing process, not a piece of paper.

Talk with Dr. Sam about the steps you're taking to improve communication with patients and invite him to join these efforts. Chances are he'll welcome your support.