Informed consent is the form that needs to be signed before any medical procedure can occur. Essentially, it is the form that allows the medical and research team to perform their duties.
Its purpose is to provide the patient with information about the procedure, the risks and benefits, who is performing the procedure and all patient rights.
“Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. (Appelbaum, 2007)1 It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.“ Jessica De Bard DDS, MSD, MA University of Washington School of Medicine
For me, it is one of the most important documents a patient will sign. It is supposed to be an opportunity to be an informed participant in the healthcare process. It is supposed to be a time when the patient is given information and allowed to ask questions. It is supposed to be a time when the patient can address any concerns and can still back out of the procedure.
Unfortunately, Informed consent seems to have lost the critical and ethical importance by medical teams. The signing and explanations have become matter of fact. In most instances, patients are not told they are signing the informed consent. It is only my savvy patients that stop providers and tell them to step away while they read it.
Recently, I was with a client who was having a lumpectomy. I told the client I wanted to be there when the doctors came through to get papers signed. I was very clear on this because what hospitals are doing now, is not allowing anyone to go with the patient during the first part of the pre op. The explanation is, well, absurd, in that a person will get in the way. It is during this time, when the patient is alone, generally anxious and fearful, that the medical team gets informed consent signed.
Usually the anesthesiologist comes first and then the surgical team. The anesthesiologist came and just talked about his role. Then he said sign this paper. Wow, hold it there buddy. I stepped in and asked if this was the informed consent. He said yes. I said, give us a minute to read it. He was annoyed as if I was creating an inconvenience.
One of the reasons it is so important to read the informed consent is that it is at this time when a patient can opt out of allowing a resident or student to do any of the surgery. There is a line that says the patient permits the physician or his/her designee to perform the surgery or procedure. It is at this time, the patient can cross out the designee and insist that only the patient’s physician do the surgery. Again, it can cause great annoyance.
In the case of my client with the lumpectomy, the surgeon had a resident with her. When my client said she only wanted her doing the procedure “from skin to skin” (from first cut to final suture), she made a face. She looked at the resident and she asked him if that was OK. He shrugged his shoulders.
Indeed there was a moment of tension. Patients have the right to say who will do anything to their body. We are not teaching and test subjects for residents and students. Those days are gone.
I have another client who won’t even let a resident in the room. I told the nurse at the clinic we need to put “residents” on the allergy list. My client tells me the residents don’t act like they care about her. They have poor bedside manners and it is clear their only interest is the procedure. If a resident comes in the room, this very sweet older woman becomes a hungry bear. She will not tolerate the game. She also reads every word of the informed consent and lines out whatever she doesn’t like.
I had on my radio show, Dan Walter, author of Collateral Damage. This is a book about a cardiac ablation on his wife that went so bad it almost killed her. This book is a must read besides possibly saving your life, it illustrates what happens when primary surgeons allow residents/attendings to do procedures unsupervised.
Dan sued the hospital, Johns Hopkins. After several years, a judge dismissed the case because the informed consent had been signed allowing anyone designated by the surgeon to perform the procedure. He wrote the book to let everyone know what had happened to his wife and how all of us are at risk.
My theme is read the informed consent. Make choices as to who will do the surgery. Be clear on what you want. I also challenge hospital administrators and medical directors to educate medical teams as to the ethical and legal importance of the document and to take the needed to time with the patient. I also would implore these same people to not have anyone sign an informed consent without a family, friend or advocate with them.