Beyond the Scalpel:
Three Questions to Ask Patients Before Surgery
A technically sound operation does not guarantee a successful outcome. In orthopedics, success is measured by whether patients can return to their lives as fully as possible. Achieving that goal requires more than analyzing imaging studies or applying surgical skill; it demands understanding the person behind the injury. By asking targeted, context-driven questions before surgery, surgeons can develop treatment plans that address both the injury and the patient’ s broader circumstances. Three questions, in particular, form the foundation of a holistic evaluation: How did you get injured? What do you do for a living? Whom do you live with at home?
How did you get injured?
The mechanism of injury is central to diagnosis, treatment planning and documentation. Yet, too often, clinical notes reduce the event to vague terms such as“ motor vehicle accident” or“ fall.” This type of brevity can overlook critical details. Was the patient a driver or a passenger? Was the car rear-ended, struck head-on or forced into a sudden stop? Was the patient commuting from work or leaving church? The specifics of the event shape not only the surgeon’ s clinical assessment but also the patient’ s legal and financial pathway to recovery.
Consider two patients presenting with identical wrist fractures:
• Patient A was rear-ended by an intoxicated driver.
• Patient B was the at-fault driver in a single-vehicle collision. 26 LOUISVILLE MEDICINE by Lucy O’ Sullivan, MD & David Seligson, MD
The radiographs may appear similar, but the contexts are different. Patient A’ s case requires meticulous documentation for insurance and legal proceedings to ensure the responsible party covers the medical costs. Patient B’ s situation, by contrast, demands careful counseling about personal liability and return-to-driving considerations.
Beyond liability, context also influences medical reasoning. A fall from a ladder at work may implicate a workers’ compensation process, while a midnight highway crash may raise suspicion for fatigue, alcohol or other contributing factors. Each detail builds a richer clinical picture, one that is diagnostically valuable and socially meaningful. Inadequate documentation increases the risk of adverse legal outcomes and can hinder a patient’ s ability to prove the claim or receive reimbursement for complications or injuries. 1-4 Capturing nuance ensures the medical record reflects not just the injury, but the lived reality of the patient.
What do you do for a living?
A patient’ s occupation is one of the most important determinants of surgical decision-making. Work is not only a means of livelihood but also a marker of baseline physical demands, functional priorities and recovery goals. Knowing a patient’ s occupation allows the surgeon to engage in shared decision-making that aligns treatment with real-world needs.
Take, for example, two patients with complex pilon fractures