A 21-Year-Old Man Arrives to the Office with Recurring Ear

A 21-year-old man arrives to the office with recurring ear leakage. His girlfriend is accompanying him. He communicates in English. On examination, the patient shows purulent otorrhea, a perforation of the tympanic membrane, and a pearly white mass behind the tympanic membrane, which is consistent with a large cholesteatoma. He is told that removing the tumor from his ear will need surgery. The patient nods momentarily but does not ask questions after hearing an explanation of the process and why it is necessary. He is also given information papers that include a written description of the treatment as well as directions on how to schedule surgery, which he promptly passes to his girlfriend, who begins reading them.  Review of the medical records shows he has been to the emergency department several times in the last year with this same concern and has not had a flu shot in the past 5 years.  Which of the following is the most appropriate course of action?

A) Ask him to schedule a follow-up appointment and bring a family member to help him make health care decisions
B) Explain again slowly and simply what surgery entails and why it should be done
C) Gently ask the patient to read the information sheet aloud to determine his literacy
D) Use a visual aid to educate the patient about the procedure
E) Verbally review instructions on how to schedule an appointment for the procedure