Consecutive Practice | Medical | General Anesthesia Consent 
 
Doctor:  Good morning, Mr. Smith. How are you doing? 
  
Patient:  I'm fine, thank you. 
  
Doctor:  When was the last time you had anything to ​eat or drink​1​? 
  
Patient:  Yesterday, at 9:30 pm 
  
Doctor:  Did you take any medication this morning? 
  
Patient:  Yes 
  
Doctor:  Since when have you been in the hospital? 
  
Patient:  Since Tuesday 
  
Doctor:  And they're giving you medication for ​high blood pressure​2​?  
 
Patient: Yes 
 
Doctor:  ​ iabetes​3​? Do you have diabetes? 
How about for d
  
Patient:  No, no diabetes 
  
Doctor:  And tell me, Are you also taking ​blood thinner ​4​ medications? 
  
Patient:  Yes 
  
Doctor:  When was the last time you took that medication? 
  
Patient:  Mmm... on Wednesday 
  
Doctor:  Okay. Let me ask you one more question: Do you have any problems with  
Reflux 5​​ or a
​ cid indigestion ​6​? 
  
Patient:  No 
  
Doctor:  Any ​loose 7​​ teeth, c
​ hipped 8​​ teeth, or m
​ issing ​9​ teeth? 
  
Patient:  Yes, some are missing and one tooth is chipped. 
  
Doctor:  Okay. Can you show me? ​Open wide ​10​ and say ​"Aaaah" 11
​  
  
Doctor:  Okay. I see it. Are you having any pain right now? 
  
Patient:  No. Right now it hurts only a ​little bit 13​
​ . 
  
Doctor:  In the last surgery that you had, did you have problems with the  
anesthesia ​14​? 
  
Patient:  No 
  
Doctor:  Any ​history 15​
​ of smoking? 
 
Patient: Yes, but I quit 10 years ago. 
  
Doctor:  Are you able to move around okay? Can you go up and down the ​stairs 16
​   
17​ 18​
without having problems of ​shortness of breath ​ or c
​ hest pain ​ ? 
  
Patient:  Yes 
  
Doctor:  Okay, we're going to do what it's called ​general anesthesia ​19​. General  
anesthesia  means  that  we  will  put  medication  through  the  ​IV  20
​   that  will 
21​
put you ​completely ​ to sleep.  
 
Once  you  go to sleep we will put a ​breathing tube 22
​  that sits in the back of 
23​
your ​throat ​ . 
  
Patient: Okay 
 
Doctor: It will stay there until the end of the surgery. ​Once we're done 23​
​ we will  
 wake you up and we'll take that tube out. 
  
Patient:  Okay 
  
Doctor:  There's a ​risk 24​
​ of i​ njury 25​
​ to lips, teeth, tissues inside the mouth, or the  
26​
vocal cords ​ . These risks are very low.  
 
There’s  also  a  risk  of  breathing problems, heart problems, or ​reaction 27 ​  to 
the medications we give. Heart attacks or s ​ trokes ​ are ​extremely rare 29​
28​
​ . 
  
Patient: Okay 
 
Doctor:  Any questions about the anesthesia? 
 
Patient:  No 
 
Doctor: Okay. ​Please print your full name ​30​ on the top line and sign at the bottom.  
 
Patient: Thank you, doctor  
 
 
 
How did you do? 
 
Grade  your  performance  comparing  your  recording  to  the  script.  You  get  one  (1)  point 
for  each  scoring  unit  you  hit,  one-half  of  a  point  (0.5)  if  the  rendition  was  ballpark,  and 
zero  (0)  if  you  missed  it  completely.  Drill  it  until  you  master  a  score  of  at  least  90% 
(27/30).  Don’t  forget  to  analyze  other  aspects  of  your  renditions  such  as  grammar, 
syntax, tonality, etc.