Every class needs a class clown -- even Joint Replacement class at Regions Hospital in St. Paul -- and I had my money on the 40-something mom who sat across the table joking quietly with her teenage daughter.

We had gathered in the hospital's cheery ninth-floor conference room -- seven people facing knee or hip surgery -- for a two-hour class on how to be good patients. Melinda, a nurse educator, reviewed medications and pain management. Ruby, a surgical nurse, covered pre-admission hygiene and diet. But when Lee, the last speaker, said you face weeks of exercise and physical therapy after a hip replacement, the mom erupted:

"I might as well keep the old one!'' she said.

We all laughed. But classes like this are no joke these days, when the health care system is under growing pressure to improve patient care and hospital outcomes.

An educated patient, the theory goes, is a healthier patient.

"I do daily rounds on the ward,'' Karen Lane, a nurse manager for orthopedics, told me. "If a patient has some understanding of how we'll care for them, they're more likely to participate in their care.''

The joint replacement class, now 15 years old, reduces patient anxiety and helps patients go home sooner, she said. Lately, Regions has added classes for patients facing spine surgery and heart procedures.

Pre-op classes reflect another trend in medicine -- a shift away from the "paternalistic'' model and toward engaging patients in care decisions, said Dr. Gavin Pittman, a HealthPartners orthopedic surgeon at Regions. "We physicians can move pretty quickly in the clinic, so patients often leave with questions,'' he said. "This allows us to spread the education beyond the doctor's office.''

In our class, for example, patients were told not to shave their legs for two weeks before surgery; even little nicks can harbor infections. And deep breathing exercises are important after surgery to prevent pneumonia.

We scribbled studiously. I believe there's a take-home exam.

Dave Hage • 612-673-7108