In every busy procedural practice, the same conversation happens dozens of times a day. When do I stop eating? What do I do with my medications? What should I bring? How long will I need help at home? When can I drive? Is this amount of swelling normal?
All of these questions are reasonable. Patients ask them because the answers matter and because, too often, our healthcare system delivers information reactively rather than proactively. The problem is not the questions. It is that each one gets answered from scratch by different people, in different settings, at a different level of detail, over and over.
We rarely count what that repetition costs because it never arrives as a bill. Instead, we accept it as overhead, even as it consumes the time and attention of nearly everyone on the care team.
The work is invisible because it is distributed
The work is spread across the care team: the medical assistant fielding a morning call, the nurse answering portal messages, the scheduler handling a preparation question while confirming a surgical date, the APP reviewing instructions at a preoperative visit, and the surgeon using part of a decision-making appointment to explain logistics that do not require a surgeon's expertise. Each interaction may take only a few minutes, but together they add up.
Because the work is distributed, it rarely appears as a distinct expense or dedicated FTE. It shows up as a clinic running behind, an inbox that never quite empties, or staff staying late because the work took longer than expected. The hidden cost is not one large expense; it is thousands of small expenditures of time and attention scattered across the organization. Repetition is not the price of quality patient preparation. It is often a sign that patient education was never properly built into the care pathway.
Where the cost actually lands
The clinic visit
Running a surgical clinic requires staff, space, scheduling systems, and coordination, and those costs continue whether a given patient interaction produces separate reimbursement or not. Much of the routine work surrounding surgery, including preparation calls, patient education, and postoperative follow-up during the global period, does not generate separate payment. Even a dedicated preoperative visit may not be separately reimbursed when it consists primarily of routine preparation after the surgical decision has been made. Most nurses, medical assistants, and schedulers support billable care but cannot bill for their time independently.
At the same time, the most expensive and least replaceable minutes in the practice are often spent delivering some of its most repeatable information. There is nothing trivial about fasting instructions, medication management, wound care, or knowing what recovery should look like. These instructions matter enormously, but the answers are also largely predictable. Every minute spent re-explaining them is a minute that cannot be spent on the patient's specific risk profile, a complex medical history, a difficult surgical decision, or a concern requiring advanced clinical judgment. The question is not whether basic information deserves time; it is whether it requires a clinician's time every time it is delivered.
The phone and the inbox
Portal messaging solves real problems for patients. It eliminates the phone tree and the time spent waiting on hold, and it places the conversation in the medical record. Yet messaging has generally been layered on top of phone calls and other forms of communication rather than replacing them, creating another stream of work that someone must monitor and respond to.
One review of nearly 7,000 hip and knee replacement patients documented more than 47,000 perioperative telephone calls: predictable questions, asked one at a time, in volumes no one planned for. Knee replacement patients averaged more than seven calls in the period surrounding surgery, while hip replacement patients averaged more than six. The most common reasons were perioperative instructions, medications, medical clearance, and paperwork. National data also show that patient medical-advice messaging remains a sustained source of work across ambulatory practice.
A single phone call or portal reply does not look like a major operational problem. At scale, however, these interactions consume substantial capacity. A two-minute answer still interrupts other work, may require chart review and documentation, and often repeats information that could have been made available before the question arose.
Consistency
When a patient asks the same question of five people, the answers may differ. This is true within a single practice or health system, and especially so when the patient queries an internet search engine, a chat room, or an AI model.
When instructions conflict, the patient must decide which source to trust or contact the practice again to reconcile the instructions. Ad hoc education is difficult to standardize, and inconsistency creates more work and less confidence.
Day of care friction
Poorly understood preparation can surface at exactly the wrong moment. A patient arrives after eating when fasting was required, a medication was not stopped, transportation was never arranged, or an important part of the preoperative process was misunderstood.
Not every delay or cancellation can be prevented through better education; many have medical or operational causes unrelated to patient preparation. Some, however, are preventable, and the morning of surgery is far too late to discover that an important instruction never landed.
Burnout
When we go to the grocery store, we do not assume the store manager is the only person who knows where the apples are. When we buy an electronic device, we do not email the company's CEO or chief scientist to ask how to use it. Yet in healthcare, the most educated, experienced, and expensive members of the team routinely answer questions that someone else on the team, or a well-designed educational system, could address just as reliably.
This happens every day in nearly every medical practice because, in that moment, answering the patient is the right thing to do. It is also the part of the work that wears on people quietly. After two decades in clinical practice, I can say plainly that answering the same questions repeatedly is not what makes this work meaningful, and that doing it several hundred times a month leaves less of you for the patients whose questions are not routine.
In a study of primary care clinicians, those receiving more than 307 patient messages per week had roughly six times the odds of high exhaustion compared with those receiving fewer, and after-hours time in the record showed a similar association. The setting is primary care rather than surgery, and message volume is a proxy for overall communication burden rather than a direct measure of repetition. The direction, however, matches what most practices already sense: predictable communication is not a free background activity.
The same pressure extends across the broader healthcare workforce, where a national survey found that nearly half of U.S. health workers reported feeling burned out often or very often. Nurses, allied health professionals, and support staff carry much of the communication work described here. When staffing is tight, every avoidable call, repeated explanation, and conflicting instruction adds work to an already full day, and attrition leaves fewer people to absorb the same load.
The hidden cost is not one large expense; it is thousands of small expenditures of time and attention scattered across the organization.
The alternative is not less patient education
The alternative is education that does not have to be recreated by hand every time. Patient preparation should be structured rather than ad hoc, specific to the procedure and the organization rather than generic, and available outside clinic hours. It should also be presented in a format patients can actually complete and revisit when the question inevitably returns.
The evidence is encouraging, although it should not be oversold. A recent meta-analysis of 19 randomized trials in hip and knee arthroplasty found that structured preoperative education produced small but significant improvements in patient knowledge and anxiety. Not every measured outcome improved, and education alone is not a magic intervention.
Structured education is not meant to replace clinicians. It should provide reliable answers to predictable questions and reserve the care team's attention for exceptions, uncertainty, and decisions that require judgment. A well-designed platform absorbs repetitive work while preserving an easy path back to the clinical team when the patient's needs are not routine.
What it is worth
In a world of rising procedural volume, declining reimbursement, and staff shortages, “work smarter, not harder” has become a cliché. “Work at the top of your license” is another. The principle behind these ideas remains useful: highly trained people should spend their time on work that requires their expertise, while reliable systems handle necessary but routine work.
Patients want better information, but they also want their care to feel personal. Direct communication about routine issues helps build those relationships, and even the best-designed education program will not eliminate every question. Nor should it. The goal is to answer predictable questions proactively so that the conversations that remain can be more personal and more clinically meaningful.
Making quality patient education part of the clinical infrastructure can free up time for atypical patients and challenging decisions while reducing the communication burden on the entire team. It will not solve burnout or staffing shortages, but it is one of the few interventions that can improve quality while reducing operational load. Compared with many large-scale workflow initiatives, it is also relatively inexpensive and straightforward to implement.
Selected References
Centers for Medicare & Medicaid Services. Global Surgery. MLN Booklet MLN907166. December 2025.
Kheir MM, Rondon AJ, Bonaddio V, et al. Perioperative Telephone Encounters Should Be Included in the Relative Value Scale Update Committee Review of Time Spent on Total Hip and Knee Arthroplasty. Journal of Arthroplasty. 2019;34(8):1563–1569.
Holmgren AJ, Apathy NC, Sinsky CA, et al. Trends in Physician Electronic Health Record Time and Message Volume. JAMA Internal Medicine. 2025;185(4):461–463.
Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. Journal of the American Medical Informatics Association. 2020;27(4):531–538.
Nigam JAS, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health—Quality of Worklife Survey, United States, 2018–2022. MMWR Morbidity and Mortality Weekly Report. 2023;72:1197–1205.
Lloyd A, Verma S, Crane L. Preoperative education for reducing patient anxiety in elective hip and knee arthroplasty: a systematic review and meta-analysis. Perioperative Medicine. 2026;15(1):11.
