People, in general, only want to be communicated with and to know the risks associated with any procedure—be it medical or not. Personally, I believe that doctors should communicate normal risks found with procedures. If there are rare, but life threatening risks, the doctor should mention them out of courtesy, but it should not be required of the doctors. However, I also believe that it is unrealistic for doctors to communicate all of the rare risks associated with said procedures. Patients should research the procedure or medication prior to consenting to it, this way the patient will be able to ask well thought out questions. Because this should be happening, it means that patients need to be aware of what the doctor suggests with plenty of time to research and become used to the idea. Lidz points out that often patients are not fully aware of the procedure and risks until the night before. Perhaps having a group of professionals at a hospital or health care center to fully explain risks and benefits to patients is what is needed. Instead of placing full responsibility on the doctor or nurses, maybe explanations need to be delegated to a special staff trained in communicating with patients.
Patients also need to understand that any medical procedure is unnatural and all procedures carry risks, some more serious than others. It is also important to keep in mind the possible benefits of medical procedures and to weigh the risks and benefits. Because this takes some experience, doctors should clearly explain and give their personal recommendation. Because patients generally do not understand medical terms, it is important for doctors to communicate in simple, everyday terms. This is a barrier that Lidz hints at, but never fully comes out and states. This barrier is one between the knowledge of doctors and the knowledge of patients.
In a way, failing to adequately inform patients of risks is comparable to the food industry failing to inform consumers about the genetically modified food which has been shown to cause health problems. I use this example because, similar to informed consent, it is a topic that is often overlooked. In general, people only want to be aware of risks associated with anything that goes into their body. It is when they unknowingly take medications with severe, common risks that they become reasonably upset.
An interesting blog, written by Dr. Bernstein, brings up the issue of informed consent of “the level of resident participation.” Most patients consent to having a resident on the team during surgery, but often are unaware of how involved the resident is. According to the statistics found in the blog, “consent rates decreased from 94.0% to 18.2% as the level of resident participation increased.” Again, communication between doctors and patients is key to a well working environment to benefit everyone the most.
In conclusion, informed consent has evolved a great deal in the last century. However, there is still room for improvement.
M. Bernstein. (2013, September 16). Patient Informed Consent for the Teaching Hospital “Trainee” Care: Informing Realistic Scenarios. Retrieved from: http://bioethicsdiscussion.blogspot.com/2013/09/patient-informed-consent-for-teaching.html
Lidz, C. W., Meisel, A., Osterweis, M., Holden, J. L., Marx, J. H., Munetz, M. R. Barriers To Informed Consent. In S. Holland, Arguing about Bioethics (299-307). New York: Routledge.
It is very interesting that you believe doctors do not need to inform patients of all rare risks involved in a procedure. I disagree with this statement, because no matter what the risk it is seemingly unlawful to hide this information from the patient. What if the unmentioned risk was one that would change the patient’s opinion on going through with the procedure? Also, what if the risk was not mentioned and for some reason it did happen, then the doctor is in trouble for not alerting the patient in advance. Reasons like these are why I believe the only safe way to approach the situation is by being completely honest. On another note, I liked the comparison between lack of informing about procedures versus lack of alerting customers of genetically modified foods. Both are prominent issues, because they represent a lack of full information to the patient/customer. In my opinion, lack of information in medical procedures is more serious because of immediate health dangers following an operation. Regarding genetically modified foods, there are also health defects but most appear slowly over time in a less serious form. Overall, I do agree with your point that there is definitely room for improvement when it comes to communication.
Though I enjoyed reading your post, I disagree with you when you say that patients should do their own research about the medication they receive because, in reality, they most likely won’t understand the information they will find. The internet has a wide variety of sources that often contradict each other. When people aren’t educated about a certain topic, they won’t know which article to believe. Therefore, I liked your point how doctors should communicate in simple words to their patients so that they understand their side effects of the medication.
Additionally, I may agree with you that doctors shouldn’t be required to mention the rare risks unless the patients directly ask them. I believe that when doctors share such information, it may elicit hope in the patients when the doctors should really instill it in their patients.
I also liked your connection to the food industry because, just like doctors should inform their patients of what they put in their bodies, the “food giants” should inform their “patients” (us, the consumers) of all of the processed foods we put in our bodies.
From the way I read your post, I took your counter-plan to the status quo to be that while doctors should explain the majority of the benefits, risks, and overall scheme of the procedure with the patient, it is then up to the patient to partake in some personal research, and if they have questions, to communicate with a set group of professionals (not the doctors) who are trained to answer and clarify the procedure at the level at which the patient can understand.
This counter-plan seems ideal, but I can see some minor flaws. First, we must look at the time frame. In a situation like this where there are at least three parties involved, there may be some difficulty in coordinating the knowledge flow, especially if the procedure has a deadline, for example, an emergency transplant. Second, time plays a double role, where a patient may not have the time outside of being a student, parent, employee, to do the research and then visit another person. Finally, a doctor is trained to diagnose and to explain to the patient what is going on in their bodies. If the patient does that by themselves, what’s the need of a doctor?
Overall, I really enjoyed and agreed with your perspective in regards to the importance of communication.
While people should strive to do their own research, it is unreasonable to expect the average person to understand how to sift through the plethora of information that is out there – after all, that is why they go to the doctor in the first place: they don’t know enough to care for or heal themselves. Some ways to improve communication could be improving health literacy, so that people know how to navigate health care, in addition to the overall benefits that better education would have.
I agree that communication is one of the most important thing for decision making on treatments. In order to have a good communication between the patients and the physicians, I believe that patients should know the common risks and life threatening risks even if they are rare. You mention that it isn’t required for physicians to tell those rare life threatening risks, but do you know that “rare” risks can still occur? If you don’t tell the patient beforehand and the patient gets the undesired consequences, the patient will probably sue the doctors. Sometimes it might be too hard or time consuming for the doctors to tell the patients about the risks; therefore, the idea about having a group of professionals to entirely explain the risks of the treatment may work. However, having the patients researching about the procedures and risks of the treatment might not be a good idea, because it defeats the purpose of having doctors. Patients come to the hospital to receive professional suggestions and treatments because they might not understand the medical terms or have the skills to research. Patients doing research on their own can be a support for knowing more about the treatment but it can’t be entirely relied on, because the communication is the key.
I agree that the concept of informed consent has evolved a great deal in the last century. I personally believe that the subjective standard of informed consent leads to the best results for the patients in most situations. In this standard, the patient gets the information that he or she in particular needs to know to make an informed decision. However, due to the changing relationship of doctor to patient in less years this is more difficult to do. In order for this process to work well, the doctor really has to have a relationship with the patient, understand how the will react to the risks, and understand what level of medical knowledge they will be able to comprehend. With shortening appointment times, I don’t think doctors these days have close enough relationships to make these kinds of decisions for their patients. Your idea in having a team made at the hospital to be the people who patients can go to with questions about the procedure is a very interesting concept. I think that would likely work well. While the doctor would still have to provide basic info and risks, patients could be referred somewhere else for more in depth questioning.
While reading your post, the issue of health literacy came into my mind. Many Americans are actually health illiterate, which is why I don’t fully agree with you that patients should do personal research. If patients don’t fully understand what the doctor is saying, then I doubt they will understand the information they find online. Even if the patient looked at scientific articles, the patient might have a hard time understanding the information if he or she has an average or low health literacy. In addition to that, there is so much information online that it is hard to know which ones are accurate. Search engines, like Google, give subjective search results so they cannot be fully relied upon.
On the other hand, I liked how you mentioned that doctors should communicate in simple, everyday terms though I think there is still a lot of room for improvement. There’s a big gap between the doctor’s knowledge and the patient’s knowledge so a middle ground should somehow be reached.
Cara,
I don’t think it is possible to share all rare possibilities with the patient because in many cases even a doctor doesn’t know the true outcome. Every surgery, big or small, has a risk. I personally know people who have gone for simple surgeries, but end up in ICU because of some rare side effects or other complications. It was also witnessed in Canterbury’s case that his surgery resulted in his paralysis which I thought was not doctor’s fault at all. On Harvard’s website: https://www.rmf.harvard.edu/Clinician-Resources/Guidelines-Algorithms/2011/General-Informed-Consent-Guidelines, one of the guidelines states that “The type and the number of risks to be disclosed should depend on the significance the doctor’s patient would attach to such risks in deciding whether to consent to the procedure or treatment. (The court recognizes that such disclosure does not apply to all “remotely possibly risks of proposed treatment” which may be “almost without limit.”).
In every surgery, a “remotely possible risk” is death, but a doctor cannot include death in all consents. Also, if a person is about to go for an appendectomy in which he has an extremely low risk of death, and if his doctor tells him that he might die during or after surgery, do you think that person will still go for the surgery and even if he does, will he be optimistic at all about his recovery? Therefore, I believe that a physician should choose to only emphasize the most possible complications and not every little thing that can go wrong with the procedure.
My thoughts strongly resonate with those presented my Sabrina, Mckenzie, and Kerrie. Having taken a wide array of science courses at Emory, I am just learning how to critically analyze the scientific evidence that exists online and in the numerous academic journals; it is easy to believe every New York Times Health Article, despite many of the backed by weak evidence. Much of the real evidence is complex and often contradictory from other sources, and therefore, I disagree with your remarks about how it is the patients responsibility to be fully informed. I believe there are both inequalities in education and economics that prevent a patient from being informed, but beyond that, there is medical knowledge inequality–“big gap between the doctor’s knowledge and the patient’s knowledge,” as stated by Kerrie. I would even argue a large majority of us struggle to be completely informed patients, and doctors cannot make an assumption they are speaking to a completely informed patient when allowing a patient to make a clinical decision.
The AMA Foundation produced an eye opening clip that the state of health literacy in our nation: http://www.youtube.com/watch?v=cGtTZ_vxjyA
The video makes me question how much consent can an individual give when they are health illiterate, as brought up by Kerrie? Is the patient fully autonomous in our current healthcare system when doctors are not explaining ALL risks? The idea of autonomy can be linked to beneficence, and in order for doctors to comply to both these principles, a physician must explain fully all risks and details involved in treatment or procedure, and after informing a patient, the physician must honor the patient’s decision. Yet, the issue of health illiteracy must be tackled by our healthcare system and physicians in order to figure out how to fully inform patients, thus giving them total autonomy.
I completely agree with your points that it is the doctors role to inform the patient of the common risks, but not the rare ones. If the doctor alerts the patient of the rare risks then they would have to measure what exactly rare means in the situation. If the rare incident applies to the situation, then the doctor should inform the patient of possible outcomes. It was also mentioned in class that if the situation happens to be life style changing then the patient should also be informed. However, it is the doctor’s role to use proper discretion to inform the patient. If there is something that the patient would like to know then the patient should ask questions and seek information. The patient also has a role, and the patient does not execute their right to this information then it’s not the doctor’s fault. They can’t disclose everything, because if they were to say everything then that would be way too time consuming and in a way not purposeful.
Nurses are actually the people you say we need, a “special staff trained in communicating with patients.” The nurses are the ones who have a lot of contact with the patients, and actually play a large role in making patients feel comfortable and well informed before procedures. Their role is vital because doctors often lack the time to sit down and talk to patients for a long time. Actually, and interesting thing to note is that the MCAT has started focusing more on psychology and bedside manner in MCAT2015. They are adding in a “social and behavioral sciences section (aamc).” They are calling it “A Better Test for Tomorrow’s Doctors.” And I agree, neither doctors nor nurses should have to remember/recite a laundry list of risks for procedures. This is an unrealistic expectation. However, patients should be provided the information somehow, whether they search the internet at home, receive a pamphlet, or ask healthcare professionals.
AAMC. 2011.
AAMC. 2011.
AAMC. 2011. https://www.aamc.org/students/applying/mcat/mcat2015/
I find it interesting that this is titled “Communication is Key” when so much emphasis seems to be placed on the consumer of health care, instead of the provider. As others have already found and pointed out here, the argument that patients need to be more aware is flawed. It is important to remember the average person does not have a college education and research skills, however simple that may seem to us current students who are well informed on ethics and healthcare.
Another point that I was concerned about was that your opinion included that the patient is responsible to do research ahead of time. There are many cases where some care must be administered immediately and there would not be time for this. In other cases, the person simply would not have access to medical literature or someone who can translate (The US, for instance, has no official language).
If it is not the responsibility of the doctor in such case, at least then you can consider including an argument for medical literacy interpreters and translators to be more integrated into the healthcare system you write in mind of.
Communication is important but works best when practiced honestly by all parties involved.
Obviously communication is very important in terms of everything. But it should be very honest else it is of no use at all. This is a good article thanks for sharing.