Beyond the signature 

By Jinny Suk Ha, MD,  University of North Carolina Chapel Hill 

He arrived with a thick folder of scans, pathology reports, and notes—evidence of weeks spent trying to make sense of a new diagnosis. His body was tense as he said, “They told me I need my esophagus removed . . . but I don’t know what that really means.” 

We often imagine that informed consent begins when the form is printed and ends when the pen lifts. But for patients facing a major procedure—especially something as life-altering as an esophagectomy—the signature is the smallest part of the process. 

As we talked, I explained the operation: the incisions, reconstruction, hospital course, and the risks. But it wasn’t until I asked him what he feared most that the real conversation began. He didn’t mention anastomotic leak rates or recurrent laryngeal nerve injury. He asked whether he would be able to eat with his family again. Whether he could go back to gardening. Whether he would ever feel “normal.” 

That was the moment I realized the consent process had very little to do with the form in front of us—and everything to do with helping him imagine the life that might follow. 

Understanding grows when we meet patients where they are. In other words, placing the conversation of informed consent within the context of the patient’s lived experience behind the medical decision. 

The importance of giving patients context 

Esophagectomy is one of the most challenging conversations we have in thoracic surgery. It’s high-risk, complex, and transformative. We can describe the complications clearly, but the deeper challenge is conveying how profoundly this operation impacts a patient’s identity, relationships, and daily routines. 

Thanks to the internet, patients rarely struggle because they lack data. They struggle because they can’t yet picture their life after surgery. They need space to ask questions that feel “non-medical” and that are central to recovery, like: How will I eat? Will I be able to enjoy food again? What does life look like a year from now? 

In addition to explaining a procedure, we need to help them envision a future. And then understanding can follow. 

Practical ways to foster real understanding 

1. Start with the patient’s goals.

Before diving into the operative approach and risks, ask: “What matters most to you as you think about surgery?” Their priorities can help shape this conversation and inform the patient’s expectations. 

2. Normalize questions that feel “small” but carry meaning.

Eating, energy levels, social routines—these are often the questions patients feel hesitant to ask, yet they define recovery. 

3. Use plain language and repeat key points.

Clear, consistent phrasing makes complex concepts more accessible—and easier to recall. 

4. Pause frequently and invite reflection. 

Simple prompts like “How does this sound so far? What part feels unclear?”  

When informed consent becomes more than a signature—rooted instead in curiosity, context, and connection—we elevate both the process and the trust that defines exceptional care. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.