Informed consent is general information distributed to each patient. Despite the efforts made by the consent forms to notify the patient of the risks of the procedure, the content of the forms are often disregarded. The questions then rise with how detailed should the content forms be. Should the debriefing of the dangers of the procedure be mainly done by the doctor or should the information be strictly attached to the form. I believe that there should be a combination of both. The patient should be informed about the severity of their surgery through the form, and the doctor should warn the patient about the basic risks of the procedure. Although not as overlooked as Terms and Conditions, the consent forms do serve a pertinent purpose for both the patient and the doctor. The goal here is to communicate to the patient the general risks of the procedure. However, then the question is what exactly should not be shared? Should the doctor discuss the rare cases that may occur with the procedure or not? I believe that the doctor should try to translate medical terms to lamest terms, but they don’t have to go in depth on rare cases unless it is fitting to their condition. I also think that the time information is conveyed should also be a concern. They should be given enough time to contemplate whether they would like to continue with the procedure or not. The patient and doctor should both be held responsible to effectively communicate with each other their concerns with the treatment. If communication is not present then there will be a disconnect with the information given.
When thinking about how the patient is informed, we must also consider the doctor and patient relationship. Some doctors aren’t personable, but establishing a healthy connection between the doctor and patient is pertinent. When this relationship is formed, it builds trust. Also, the doctor becomes more understanding of how the patient feels generally and about the surgery. As a result, the doctor would have the patients’ best interests at heart. According to Schumann, establishing a patient doctor relationship has therapeutic purposes and is one of the main goals for a doctor during practice.
As stated in the text by Lidz there were four reasons that patients desired information: “Information of Compliance, Courtesy, Veto, and Decision making”. The reasons are understandable, and the patient has a right to this information. Some patients assume that the doctor simply knows what they’re doing, and will do what is best for them. However, Lidz made a great point that out of respect for the person patients want to be informed. The relationship between the doctor and patient would contribute to the degree of courtesy and amount of information that is disclosed. People are unique and respond differently to information when communicated. However, the patient must also question the doctor about certain issues they have. They also have a duty to ask the doctor about certain things that would affect them that the doctor may not be as informed about. The decision of the procedure should ultimately be a combination of the doctors expertise and how the patient feels. Quite naturally, there will be things that the patient does not understand about the procedure, but it is the doctor’s duty to inform the patient as much as possible with sufficient information prior to the procedure.
References
Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.
Kegley, Jacquelyn Ann K. “Challenges to informed consent” EMBO reports, 2004. 832-836.
Suchman, Anthony L. M.D., Matthews, Dale A., “What Makes the Patient-Doctor Relationship Therapeutic? Exploring the Connexional Dimension of Medical Care”. American College of Physicians. 1988; 108; 125-130.
Informed consent is basically a process of building trust between the patient and physician via communication. That is why in my initial blog entry: Informed Consent: It is your pick, I said that the process of informed consent has become a legal formality instead of a process of meeting of two minds, agreeing to one thing. The original purpose of the informed consent as outlined by the court in Canterbury v. Spence was that the process should be considered as a professional duty of a physician to share information with the patient. Initially, the doctor patient relationship was based on the idea that the doctors know the best. However, the rapid changes in the healthcare industry have placed a heavy burden on this relationship. This relationship has evolved; the emphasis has shifted from what physicians normally disclose to what patients wants to know. There is nothing wrong in this ideology. Physicians should not have any problem explaining their concerns to their patients, unless there is a hidden motive in it. Similarly, patients should also trust their providers as their health advocates who will give patients the best care possible. So, to emphasize on what you were saying about “rational consent”, I agree that all the paperwork, and documents are irrelevant and are legal complications. This relationship needs to take a step back and each party has to evaluate what’s in there for me and build a partnership based on mutual gains.
Sorry please disregard the above comment… Below is my response to this post…
I completely agree with you that Doctor/ Patient relationship is a partnership and best results can only be achieved with mutual decisions. As we read that after Canterbury V. Spence, paternalism approach in medicine has not only become unpopular, but is widely thought not to be a part of medicine anymore. Today, Patient autonomy is the only legal way. We went from one extreme to the other. You are correct in that why can’t we have a middle ground where both doctors and patients can make mutual decisions. I believe in patients’ autonomy, but I also think that patients sometimes cannot make up their mind as to what they really want. Patients’ decisions are usually based on emotions; family and friends, also influence their medical decisions. Their choices may change based on what they read on internet or hear from friends and family. For example, Angelina Jolie’s preventive double mastectomy has influenced many women to run to genetic counselors. However, many physicians strongly feel that preventive surgeries are unnecessary. Patients need to think twice before making such drastic and irreversible decisions only to reduce risks because some of these risks may not even be present or in the future, can have better resolutions. Dr. Peter Ubel in his book Critical Decisions says that “one size fits all policy [of informed consent] will harm people…too often it has left doctors and patients caught between paradigms” (Ubel, 17). I agree with him and I agree with you that instead of going with either autonomy or paternalism, we need to come up with an interactive decision making process.
“Should the debriefing of the dangers of the procedure be mainly done by the doctor or should the information be strictly attached to the form?”
I really liked how you incorporated these questions because I also believe that both of these should happen. Information should be on a consent form so that the patient can read it and have a general idea of what he or she is getting herself into. However, I think that the doctor should mainly do the “debriefing” because this facilitates the doctor-patient relationship that you talk about.
The doctor-patient relationship is extremely important because, more than just trust, the doctor and patient learn to understand each other and can, therefore, be extremely honest about certain conditions and information that should be shared between them. The whole idea of communication is such a bigger deal than people make it seem to be. Communication really is key. If information was simply on a consent form, patients wouldn’t necessarily understand all of the medical wording or some may not even take the time to look at it because they don’t care enough. Once a conversation starts between the doctor and the patient, there’s this on-going understanding that they can pretty much share any information with each other and inform one another about any problems or suggestions each has.
You state that “despite the efforts made by consent forms to notify patient of the risks of the procedure, the content of the forms are often disregarded.”
This reminded me of the case of Jahi McMath, the girl declared brain dead after a tonsillectomy. While I’m sure her parents received a form stating the risks of a tonsillectomy, I don’t think they took the risk of death very seriously since it is such a common procedure. I think this is one of the downfalls of informed consent. While her best interests were clearly at heart when the tonsillectomy was blamed, how could anyone predict what would happen next? How can this rare of a consequence be accurately portrayed to patients, or does it not need to be since it is so unlikely to happen?
I agree with the fact that it is the doctor’s responsibility to inform the patient about procedures as well as the patient’s responsibility to be informed about procedures. Sometimes, through no fault of the doctor, the patients distance themselves from the doctor because they don’t want to seem ignorant, don’t want to trust the physician, or don’t know how to communicate their concerns. Indeed, it would be helpful to establish a rapport with the doctor, but what if the patient doesn’t wish to do so due to apathy? If the doctor is impersonable, how can the patient be sure that they are in the right hands?
We are facing a changing time in terms of doctor patient relationships. There has been much criticism towards medical schools regarding who exactly are being admitted to medical schools. You hit on an interesting point when you bring up the personality of the physician, and whether we are willing to admit it, the personality of our physician greatly impacts our doctor’s visit and how open we are. We will be less inclined to ask a seemingly cool, unapproachable physicians questions, while we are more likely to put our trust in very personable.
In the book, “How Doctors Think, Groopman focuses on one major aspect of the doctor-patient interaction: how it influences a physician’s diagnosis, and even his or her ability to make a diagnosis. His stories show us instances where a doctor makes snap judgments that are wrong and right– where past cases distort present perception, where rapport with, or dislike for, a patient alters diagnosis or care. The hippocratic oath taken by every medical doctor to do no harm needs to detail physicians the danger of personality or the danger of putting a patient into a “cognitive schema.”
We need to be active patients, seeking to challenge the cognitive paths of our medical doctors, and we need to be aware of the effect of personality and judgement. An active patient can ask the MD questions that will encourage critical analysis of his or her clinical decisions and recommendations and ensure that the recommendation is backed by evidence or experience, not an existing mental schema.
In response to Zian’s comment I do not believe that paternalism is becoming extremely less popular in medicine. I agree that patients are becoming more informed, especially with all of the medical information that is available, but there is a huge gap between those who are able to access that information and those who are not. In many cases, those who are unable to receive medical care are treated with paternalism. This may be due to prejudices or other contributing factors.
More bluntly stated, I think certain patients are treated differently. Patients who have a PCP and regular access to care are given the opportunity to act more autonomously, but those who are only able to see a doctor one time or on occasion are simply not given as many options. Those patients are the ones who are seen quickly, rushed through mass appointments, and are not able to have the time to gain enough information to truly have autonomy.
I believe there is a more significant reason that consent forms are around, and that involves the security of the doctor and medical care center they affiliate with. Thus, when you say, “Although not as overlooked as Terms and Conditions, the consent forms do serve a pertinent purpose for both the patient and the doctor. The goal here is to communicate to the patient the general risks of the procedure,” I believe it is missing the legal point of view. I do not think these forms will go away no matter how little they are read, because should something happen they have agreed under law that they placed their health in the hands of someone else.
Now, to further address this specifically, there can be some amendments. For instance, there may be a mandatory sort of test that examines the understanding of the documents, or someone that can provide translation of them to another language if needed. In terms of including rare side effects, it is in the interest of the doctors to include them.
The physician-patient relationship is often unbalanced, as an undue burden is placed upon the physician. While I do agree that it is the doctor’s responsibility to inform patients, it is equally the patients responsibility to become informed. In many circumstances, patients almost entirely remove themselves from their treatment process, assuming that their physician will make all decisions in their best interest. While trust is an essential aspect of this relationship, it does not override the patient’s responsibility to remain attentive and informed about their course of treatment.
As mentioned by Lidz et all, a patient may have varying reasons for wanting or not wanting to know information about their medical treatment. Despite these reasons, a patient must still retain a basic level of knowledge about what is going on, otherwise the physician is given too much power in medical decision-making. While the informed consent doctrine seeks to keep patients informed to an extent, it does not always ensure that patients are taking an active role in their health.