Patients are often silent because they are overwhelmed by the fear of the impending procedure, do not know how to structure a meaningful and clarifying question and chose to believe that surgery offers them a guarantee of complete resolution of pain.
Among the data that you need to have secured are:
a. Does this patient have any past surgical experience
b. Has any of the patient_s family or friends had spinal injuries and/or procedures
c. What would the patient perceive as _successful surgery_
d. What alternate career plans has the patient considered
e. How heavily are financial burdens weighing on patient and family
f. How has the patient_s role as a spouse and/or parent been altered
g. How has the family_s perceptions and treatment of the patient changed as a result of injury and limitations
h. How compliant has the patient been with a fixed schedule of pain medication
i. How compliant has the patient been with diagnostic and conservative measures up to this point
In effect, a silent patient, about to undergo spinal surgery is not necessarily a patient who understands the procure, is prepared for its aftermath and/or who will comply with post-surgical rehabilitation.