May I delegate to a medical assistant to call a patient and inform them that the surgeon recommends physical therapy with a custom‑made brace and a follow‑up appointment in three weeks instead of surgery?

Delegation of Surgical Treatment Plan Communication

Yes, you may delegate to a medical assistant (MA) to call the patient with the surgeon's recommendation for physical therapy with a custom-made brace and 3-week follow-up instead of surgery, but this delegation has important limitations and requirements.

Key Principles for Delegation

The legal responsibility for informed consent and treatment plan communication lies with the surgeon, not the MA 1, 2, 3. However, communicating a treatment decision that has already been made can be appropriately delegated under specific conditions.

What Can Be Delegated

The MA may relay:

• The surgeon's specific recommendation (physical therapy with custom brace)
• The follow-up timeline (3 weeks)
• Scheduling information
• Basic logistical details

What Cannot Be Delegated

The MA should not be tasked with:

• Explaining the rationale for choosing conservative management over surgery
• Discussing risks, benefits, or alternatives to the recommended treatment
• Answering clinical questions about the treatment plan
• Assessing the patient's understanding or concerns about avoiding surgery
• Obtaining consent for the treatment plan

Critical Safeguards

The surgeon must ensure the patient has already received adequate information about their condition and treatment options during the clinical encounter 1. The MA's call serves only as notification of the final decision, not as the primary communication of the treatment plan.

Documentation Requirements

• Document that the MA made the call and what information was conveyed
• Note the patient's response or any questions raised
• Any patient questions or concerns must be directed back to the surgeon 3
• The surgeon should document the original discussion and decision-making process separately

Clinical Context Considerations

This delegation approach is particularly relevant given that delaying surgery for trials of braces and physical therapy may not improve outcomes in patients already indicated for joint arthroplasty 4, 5, 4. The 2023 ACR/AAHKS guidelines conditionally recommend proceeding to surgery without delay over delaying for braces or physical therapy in patients with moderate-to-severe osteoarthritis who have failed nonoperative therapy, as delays can cause increased pain with limited clinical benefit.

However, if the surgeon has determined that conservative management is appropriate for this specific patient (perhaps they don't meet criteria for surgery, or there are personal/medical reasons for delay), the MA can communicate this decision.

Best Practice Recommendations

1. Establish clear institutional policies on what information MAs can communicate regarding treatment plans 6
2. Provide the MA with a script containing exactly what to say
3. Instruct the MA to document that the patient was informed the surgeon is available for questions
4. Have a mechanism for the patient to easily reach the surgeon if they have concerns about the recommendation
5. Follow up in writing with a patient portal message or letter from the surgeon confirming the plan

Common Pitfall to Avoid

Do not use the MA to deliver unexpected or complex treatment decisions that the patient hasn't previously discussed with the surgeon 1. If this is the first time the patient is hearing they won't need surgery, the surgeon should make this call personally to address questions and ensure understanding.

The delegation is appropriate for confirming and scheduling a treatment plan already discussed, not for initially informing the patient of a significant clinical decision.