What is a preoperative covenant?

A preoperative covenant is an agreement between a surgeon and a patient made before surgery. It outlines the patient's values, goals, and expectations for the procedure.

The patient provider's preoperative covenant

A preoperative covenant is an agreement between a surgeon and a patient before surgery. It aims to ensure both parties understand the patient's values, goals, and expectations for the procedure. This agreement involves discussions about desired outcomes, acceptable and unacceptable trade-offs, potential risks, and contingency plans if things do not go as expected. The goal is to respect the patient's autonomy by clarifying their values and guiding the surgeon's recommendations.

The covenant does not have to be a signed document; a verbal agreement can suffice, though written documentation helps ensure clarity. During a podcast episode on the value of preoperative covenants, Dr. Marterre offered some insight from the perspective of the medical professional, “Honoring autonomy requires eliciting and clarifying the patient’s values and helping them reflect on their values. And shared decision making really should end with the clinician, in this case, the surgeon, making a value-congruent or value-concordant recommendation…”

Without a preoperative covenant, there can be misunderstandings about the patient's wishes, potentially leading to decisions that don't align with the patient's values, causing issues for both the patient and the medical team.

See also: Patient Relationship Management - what you need to know

The role of HIPAA compliant email to share preoperative covenants 

HIPAA compliant email content and structure

1. Use specific and clear subject lines like “Preoperative Covenant for [Patient’s Name] - [Procedure Date]” to help the recipient identify and organize the email quickly.
2. In the body of the HIPAA compliant email, provide a concise summary of the preoperative covenant and include a detailed attachment. Ensure the summary highlights key points to guide the patient on what to focus on in the attached document.
3. Use plain language that the patient can easily understand, avoiding medical jargon as much as possible.
   
   

Patient engagement and follow-up

1. Request a read receipt or ask the patient to reply to confirm they have received and read the email. This can be automated with HIPAA compliant email platforms.
2. Include interactive elements such as links to videos or infographics explaining parts of the covenant. This can aid patient understanding and engagement.
   
   

Timing and consistency

1. Send the preoperative covenant well in advance of the scheduled surgery date to give the patient ample time to review and ask questions.
2. If any changes occur, send an updated preoperative covenant immediately and clearly mark the changes. Use consistent email formatting to help patients easily identify updated information.

See also: Top 12 HIPAA compliant email services

FAQs

Who participates in creating a preoperative covenant?

The patient and the surgeon are the primary participants. Other healthcare team members may also be involved in the discussion.

What topics are covered in a preoperative covenant?

It covers desired outcomes, acceptable and unacceptable trade-offs, potential risks, and what to do if the surgery doesn’t go as planned.

Is the preoperative covenant a legal document?

It can be written down for clarity and accountability but does not need to be a formal legal document.