Good communication practices are often treated as soft skills. However, in high-stakes environments like performing surgery, the way clinicians communicate may be just as critical as the care they deliver.

During a Candello Patient Safety Study Group, vascular surgeon and researcher Gretchen Schwarze, MD, MPP, FACS, challenged a long-standing assumption: that informed consent, as traditionally practiced, prepares patients to make truly informed decisions.  The reality, she argues, is far more complicated and often far less effective. Drawing on more than 15 years of research, including analysis of over 1,000 recorded clinician-patient conversations, Dr. Schwarze has examined how clinicians and patients communicate during high-stakes surgical decisions and where those conversations most often break down.

When Communication Fails, Patients Pay the Price

One of the most striking takeaways from Schwarze’s work is how easily communication gaps can lead to unwanted care. She shared one case where an older patient with multiple chronic conditions chose to undergo high-risk surgery after hearing a series of percentage-based risks. The family interpreted those statistics optimistically, focusing on survival probabilities rather than likely, unfavorable outcomes.

The surgery went as expected from a clinical standpoint. But when the patient’s family saw their loved one intubated, unresponsive, surrounded by machines in the ICU, they realized the outcome did not align with the patient’s values. Care was withdrawn soon after.

The issue wasn’t poor clinical judgment, but rather a mismatch between what clinicians said and what the patient and family understood and expected.

Why Traditional Informed Consent Falls Short

Research presented in the session highlighted several consistent patterns in surgical conversations:

• Clinicians spend most of the time explaining the disease/condition and the technical details of procedures
• Goals of surgery are often unclear or not discussed
• Conversations rely heavily on “fix-it” language, implying a return to normal
• Patients frequently feel they have little real choice

In more than 75 percent of observed conversations, the goal of care was not clearly specified, or the only goal mentioned was disease control.

The result? Patients consent to procedures without fully understanding how those interventions will affect their daily lives or whether potential outcomes align with what matters most to them.

Three Skills That Can Transform Conversations

1. Managing uncertainty with “Best Case/Worst Case”

Move beyond percentages by describing best, worst, and most likely scenarios. This helps patients understand what outcomes would actually feel like and not just the odds. 

2. Reframing informed consent around goals and tradeoffs

Focus on what matters: name the goal of surgery, discuss full downsides (not just risks), create space for deliberation, and offer a recommendation grounded in patient values.

3. Acknowledging emotions

Respond to patient and family emotions with compassion and empathy. This helps to build trust and improve decision-making in high-stakes moments.

From Better Conversations to Better Outcomes

Schwarze notes that these approaches may ultimately save time by reducing confusion, repeated explanations, and misaligned expectations.

More importantly, they help ensure that care decisions reflect patients’ goals, values, and tolerance for risk, not just clinical possibilities.

For healthcare organizations, the implications are significant. When patients receive care aligned with their preferences, the likelihood of patient dissatisfaction, moral dilemma, and potential liability decreases.

Why It Matters

At its core, this work challenges a fundamental question: Are we helping patients make decisions or simply asking them to agree to ours?

Better communication doesn’t require new technology or complex interventions, but simply a shift in mindset from explaining procedures to understanding people.

When clinicians move beyond “fixing problems” to exploring what outcomes truly matter, they create space for decisions that are both informed and meaningful.

And when it comes to the safety of your patients, that distinction can make all the difference.