Skip to main content

Patient Expectations: The Root of All Evils?

Have you ever heard the colloquialism “Don’t count your chickens before they’ve hatched"? Of course, you have. Yet, it seems in healthcare we frequently do so. This is especially true in the immediate postoperative period. In postoperative conversations, physicians will reassure the patient and family that the surgery went as planned and without complications. Then, seemingly out of nowhere, a complication arises that sets the patient back a month or more in his or her recovery and totally hits the patient like a bad surprise party. Therein lies the issue—a complication should never take a patient by surprise. Although it may be disappointing, a patient should not feel ambushed by a complication. Does the cause rest with us in our lack of adequate assessment and management of patient expectations that can end up being our litigation headline? 

Some complications take time to evolve, and we can do a better job at educating patients about potential signs and symptoms to look for. By ensuring that our patients recognize and understand what complications can occur, we draw them closer into a healthcare partnership with us. This can change the narrative from “what’s happening to me,” or worse, “what did you do to me?” instead to, “I think I’m having one of those problems we discussed.” 

On-Demand Webinar: Key Strategies for Ensuring a Profitable Independent Practice
During this one-hour program, practice management expert Debra Phairas discusses how various business models and operational enhancements can increase revenue to help your practice remain successful in today’s competitive marketplace.

It is especially important to inform the patient of complications that may not manifest in the immediate postoperative period. Infections, bowel perforations, and ureteral complications typically do not appear while the patient is in the PACU. Radiant energy from cautery, EMI/RFI, retractors, chemical agents, and other sources may have affected surrounding organs, structures, or devices, e.g., tubes. The damage caused by these sources may not be evident at the time of surgery, but arrive days later and often after the patient was told, and thinks, they are fine. In cases where the patient was not informed of the potential complications and now needs a referral to another physician, should it be any wonder why the patient does not like us anymore? 

The wise approach is to teach your patient during the consent process that some complications are immediately obvious, while others are insidious with delayed manifestation days, or even weeks later. In the immediate postoperative period, you can reiterate this point by saying, “while there are no immediate observable complications, we’re not out of the woods yet.” Such a strategy primes the patient to review the list of potential complications shared with the patient during your preoperative discussion and prompts the patient to alert you if symptoms of complications arise. Early identification of complications can reduce the time between your response and treatment. It could be the difference between a small bowel repair versus one with peritonitis and sepsis. While the patient’s experience may be disappointing, it should not come as a shock or horror to the patient with your name attached—which could happen if you told the patient postoperatively that everything was fine and subsequent complications occur. The key is to manage the patient’s expectations in advance and let adequate recovery time to pass so that you in fact know you are truly beyond the clinical timeline for complications.

This brings us full circle to the concept that “good consent is expectation management.” It’s a harmonious compilation of: (1) your assessment of the patient’s expectations; (2) a discussion of the risks and benefits of, and alternatives, to the proposed procedure; and (3) education on what is or could be expected postoperatively. If patient expectations are not appropriately managed, the immediate patient mindset can be “you did me wrong.”

As for the consent form, it is just that – a form. It is not conclusive evidence that you discussed and obtained informed evidence from your patient. You also need to document in the record your consent discussion and refer to the form for details about the discussed risks and complications.

We need to shift away from the paradigm of being the architects of our own problems by failing to understand patient expectations to one of balancing those potential versus actual results. In the end, it creates a better patient experience and fewer patient complaints and claims.    


Lee McMullin is a Senior Risk Management and Patient Safety Specialist for CAP. Questions or comments related to this article should be directed to