The stem
You are the attending anesthesiologist in an academic tertiary medical center with a full preoperative holding area, cell salvage available, and an OR board runner. A quiet corner of pre-op holding is free if you want it, and you will not be interrupted for these eight minutes. Pre-op holding, bay 3. Elena Ruiz, 58, is booked for left total knee arthroplasty under spinal anesthesia with a planned adductor-canal catheter. Her adult daughter Maria answers most questions for her. Elena nods but failed teach-back on nerve-injury risk and on what the catheter is. The orthopedic surgeon told them 'the block guy will numb it' and wants her wheeled in about twelve minutes. Your task: obtain a valid informed consent for the regional plan — or document a refusal with alternatives — without coercing Elena and without letting Maria replace her as decision-maker.
Key teaching points
- Decision-maker is the capacitated patient; family supports.
- Teach-back under time pressure beats a longer monologue.
- Honest timeline is not coercion.
Excerpt only. The full communication station runs live with the AI examiner and ends with a full debrief.