What questions should a consultant ask patients with various conditions, including a 36-year-old female with an incisional hernia, a 43-year-old female with recurrent incisional hernia, a 59-year-old male with a right diabetic foot ulcer, a 65-year-old male with a right solitary thyroid nodule, a 49-year-old male with a traumatic left hydrocele, a 20-year-old female with a right breast fibroadenoma, and a 19-year-old male with a pilonidal sinus?

Essential Consultant Questions for Surgical Patients

A surgical consultant should ask targeted questions that assess symptom severity, functional impact, risk factors for complications, and quality of life to guide optimal management decisions for each specific condition.

General Framework for All Patients

Quality of Life and Functional Impact Assessment

• Ask open-ended questions about how the condition interferes with daily activities: "How does this problem affect your ability to do what you want to do in your daily life?" and "What areas of your life are affected most?" 1
• Inquire about specific functional limitations: work capacity, physical activities, sleep disturbances, and social interactions 1
• Document the patient's description of symptoms in their own words when possible 2

Medical and Surgical History

• Obtain detailed information about previous surgical procedures, particularly any prior repairs or interventions related to the current condition 3
• Ask about comorbidities that increase surgical risk: diabetes, obesity, smoking, immunosuppression, chronic respiratory disease 4
• Screen for substance use: "How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?" 1

Condition-Specific Questions

For the 36-Year-Old Female with Incisional Hernia

• When did you first notice the bulge? Timing helps distinguish early versus late-appearing hernias 5
• Do you have pain, discomfort, or any symptoms from the hernia? One in three hernias cause symptoms, which influences management urgency 5
• Have you experienced any episodes of nausea, vomiting, or inability to pass gas? Screen for obstruction risk, which occurs in 14% of symptomatic hernias 5
• What was the original operation that led to this hernia? Type of incision and surgical technique affect recurrence risk 5
• Did you have any wound complications after your original surgery? Infection, seroma, or delayed healing increase hernia risk 6
• Are you planning future pregnancies? This affects timing and technique of repair 1

For the 43-Year-Old Female with Recurrent Incisional Hernia

• How many previous hernia repairs have you had, and what techniques were used? Open versus laparoscopic approaches affect subsequent management 3
• What is the approximate size of the current hernia defect? Defects <8-10 cm may be amenable to laparoscopic repair 3
• Do you experience chronic respiratory symptoms or difficulty breathing? Loss of domain affects respiratory function 4
• Have you had chronic gastrointestinal issues since the hernia developed? Absence of functional linea alba causes GI disturbances 4
• What type of mesh was used in previous repairs, if any? Mesh type and placement influence recurrence patterns 3
• Are you experiencing psychological distress related to multiple failed repairs? Psychosocial issues are part of complex hernia natural history 4

For the 59-Year-Old Male with Right Diabetic Foot Ulcer

• How long has this ulcer been present? Duration indicates chronicity and healing potential
• Have you had previous foot ulcers or amputations? Prior history predicts recurrence risk
• What is your current diabetes control? HbA1c levels and glucose monitoring patterns
• Do you have numbness or loss of sensation in your feet? Assess for neuropathy severity
• Can you feel when you step on something sharp? Protective sensation testing
• Do you have pain in your legs when walking that improves with rest? Screen for peripheral arterial disease
• What is your typical footwear? Improper shoes contribute to ulcer development
• Do you check your feet daily? Self-care practices affect outcomes
• Have you had any fevers, chills, or drainage from the wound? Signs of infection requiring urgent intervention

For the 65-Year-Old Male with Right Solitary Thyroid Nodule

• When did you first notice the nodule, or was it found incidentally? Growth rate assessment
• Have you noticed any change in the size of the nodule? Rapid growth raises malignancy concern
• Do you have difficulty swallowing or a sensation of something in your throat? Compressive symptoms
• Have you experienced voice changes or hoarseness? Suggests recurrent laryngeal nerve involvement
• Do you have any neck pain? Can indicate malignancy or hemorrhage
• Have you had any radiation exposure to your head or neck, especially in childhood? Major risk factor for thyroid cancer
• Is there any family history of thyroid cancer or endocrine tumors? Genetic predisposition assessment
• Have you noticed heat intolerance, palpitations, or weight loss? Screen for hyperthyroidism
• Have you experienced cold intolerance, fatigue, or weight gain? Screen for hypothyroidism

For the 49-Year-Old Male with Traumatic Left Hydrocele

• When did the trauma occur, and what was the mechanism of injury? Timing and severity assessment
• Have you noticed progressive swelling since the injury? Distinguishes acute from chronic hydrocele
• Do you have pain or discomfort in the scrotum? Symptom severity guides management urgency
• Can you transilluminate the swelling with a light? Helps confirm fluid versus solid mass
• Have you had any scrotal surgery or infections in the past? Other causes of hydrocele
• Does the swelling change in size throughout the day? May indicate communicating hydrocele
• Have you noticed any testicular masses or firmness? Rule out underlying testicular pathology
• Are you experiencing any urinary symptoms? Associated genitourinary issues

For the 20-Year-Old Female with Right Breast Fibroadenoma

• When did you first notice the lump? Duration and growth pattern
• Has the lump changed in size, particularly with your menstrual cycle? Fibroadenomas may fluctuate hormonally
• Is the lump painful or tender? Most fibroadenomas are painless
• Have you noticed any skin changes, nipple discharge, or other breast symptoms? Screen for alternative diagnoses
• Is there any family history of breast cancer, particularly at young ages? Risk stratification
• Have you had any previous breast biopsies or imaging? Prior evaluation results
• Are you currently using hormonal contraception? Hormonal influences on breast tissue
• Does the lump concern you or interfere with your quality of life? Patient anxiety affects management decisions 1

For the 19-Year-Old Male with Pilonidal Sinus

• How long have you had symptoms? Acute versus chronic disease
• Do you currently have pain, swelling, or drainage? Active infection versus quiescent disease
• Have you had previous episodes that resolved on their own or with antibiotics? Recurrent disease pattern
• Is there active drainage, and if so, what does it look like? Purulent drainage indicates infection
• Have you had any previous surgical treatments for this condition? Prior interventions affect recurrence risk
• What is your occupation and typical daily activities? Prolonged sitting exacerbates condition
• Do you have excessive body hair in the area? Risk factor for recurrence
• How does this condition affect your daily activities and quality of life? Functional impact assessment 1
• Have you had fevers or systemic symptoms? Severity of infection

Documentation and Communication

• Record all relevant findings and patient responses to facilitate continuity of care 7
• Communicate recommendations clearly to the referring physician without patronizing, educating without lecturing 7
• Provide patients with written information about their condition when appropriate 2