Prior to having read some of assigned essays on informed consent, I believed it to be a relatively cut and dry issue. Many of the articles or videos that I have reviewed on informed consent seem for the most part repetitive. Informed consent is important—a good thing. Without policies that detail protocol doctors must follow in regards to their treatment of patients, who knows how a patient may be taken advantage of? After all “doctor knows best”; if the law does not stand to protect the rights of patient, who will? Should a patient be of sound mind and of age, they should be given full disclosure regarding the purpose of a medical procedure, the risks and benefits, probability of risk as well as alternatives to treatment (Brody, 283). I am not a doctor and thus am only able to see things from the patient’s side of the informed consent debate. It seems simple, really. For a physician to balk at the idea of thoroughly briefing and obtaining permission regarding what happens to their patients’ bodies is ridiculous, right?
If informed consent is so great, though, why do so many physicians see it in many cases as unnecessary or frivolous? In the process of searching for interesting essays or articles on informed consent from a physician’s perspective, I stumbled upon a brief opinion piece by John Kelly IV, an MD who is a regular writer for Outpatient Surgery Magazine. Although the opinion was humorous, I think it did a decent job of shedding light onto the ways in which informed consent may be good in theory, but not in practice. Two of the problems that he focuses on in particular are “nitpicking” and “catastrophizing” (Kelly). The consent form is a legal document and of course important; however, how explicit do they really need to be? It is one thing to list possible risks for a certain procedure—that is for the patient’s benefit. But how detailed does a doctor need to be in describing a surgery that is a part of their daily routine? Forcing doctors to stress and go back over every word in a consent form is a waste of time and if anything, could cause them to lose respect for and patience in the process of informed consent.
The major issue that doctors seem to be concerned about when it comes to informed consent based upon my and other students’ posts seems to be “catastrophizing”: the idea that being too explicit in the risks of procedures, some of which are incredibly low, can lead to discouraging patients to receive the treatment and care that is essential to their health (Kelly). How much information is too much?
I am not at all saying that the cons of informed consent outweigh autonomy, which is the moral issue at the center of the argument. I do, however, believe that there should be a movement to standardize policy across states to make the issue a little less hazy for all involved as well as help to maximize the use of doctors’ time. Solutions that I can think of include an official electronic database on which the risks of various standard procedures are outlined so that patients can clearly view the costs and benefits prior to giving consent. Another option would be to hire hospital staff or train current staff to specialize in patient relations; people who can to sit down with individuals and talk them through the risks and alternatives, as well as their doctor’s recommendations. I am not sure what other solutions have been proposed or initiated; but until a larger solution is settled upon, the autonomy of the patient will continue to trump physician convenience and efficiency, and rightly so.
Brody, Baruch A., and H. Tristram. Engelhardt. “Adult Patients: General Issues.” Bioethics: Readings Cases. Englewood Cliffs N.J: Prentice-Hall, 1987. 282-86. Print.
Kelly, John, IV. “Cutting Remarks: (Mis) Informed Consent.” Outpatient Surgery Magazine. N.p., Feb. 2014. Web. 17 Feb. 2014. <http://www.outpatientsurgery.net/outpatient-surgery-news-and-trends/humor-and-jokes/cutting-remarks-mis-informed-consent–02-14>.
8 thoughts on “(Mis) Informed Consent: A Doctor’s Perspective”
Sure informed consent is necessary, but it is also tedious. Hence, the invention of the consent form. However, these fail to explain the procedure to patient in a manner in which they can fully understand the consequences and risks for the procedure or treatment. The patient is then faced with asking the doctor or other medical professional for clarifications. Of course, the doctor would be the best person to ask because they are performing the procedure or administering the treatment and know the patient’s circumstances. But what if they ask another medical professional who is unaware of the patient’s circumstances? Also, patients now have access to the internet and often utilize this technology to gain a better understanding, yet they may even go as far as utilizing this online advice as a means to self-treat themselves. This can make informing the patient difficult because now the physician would have to explain or convince the patient that everything online should not be taken seriously, especially since there is no way that the internet has information that caters to an individual patient’s situation. Perhaps, the physician should go into details in order to ensure that the patient isn’t misinformed by an outside source, or they could possibly allow the internet to cover the in-depth details that they don’t have time to cover themselves (or if they find those explanations tedious). The online information basically acts as a double-edged sword.
I really enjoyed reading your post because of the many questions you asked. I like your transformation from praising informed consent to questioning it. I agree with both of your points. I think that informed consent is also a huge deal because of a person’s autonomy, however, I understand (or, at least, try to) the frustration and impatience of the physicians when having to disclose “unnecessary” information. I’m not sure how long an informed consent form is, but I think it’d be important for a physician to at least go over the basic risks/benefits/procedures with the patient. Like you mentioned, there should be solutions to this issue. One specific solution you said really stuck out to me. I liked the idea of hiring specialized physicians that can develop this doctor-patient relationship that the medical system nowadays has basically ignored. This solution could potentially be very helpful. Also, maybe the consent form should be short enough where it could even be in bullet-point kind of form. Patients don’t want to read pages and pages of words that they barely understand. Therefore, it would be helpful if there were people in hospitals/doctor’s offices that could simplify all of this information into about a page that has words that the patient would understand.
While having specialized staff to talk to patients about their condition and treatment is a good solution for the issue of informed consent, I think it would have negative repercussions in regards to the physician-patient relationship. At least for me, I go to certain doctors because I like them and trust them. I know they are implementing the best course of action and would answer any of my questions to the fullest extent. If I had to be shuffled to another site in the office to go over the informed consent of the treatment, it would upset me. Also, wouldn’t the new specialized staff take over a crucial part of a physician’s role? Not to mention, it would also increase the time that people have to spend in the doctors office, an outing that already peeves most impatient people.
I think a central issue with the consent form process is that the consent form has become a legal document merely apart of the process of getting a procedure done. The relation to legality affects how patients interpret the meaning of the form. First off, the signing of the consent form has become a routine prerequisite to getting a medical procedure. Then I believe many patients interpret the consent form as a way of acknowledging that their are risks to the procedure and thus they cannot take legal action against anyone (i.e. the hospital, the medical doctors, etc.) post-procedure, unless there was an error made during the procedure. Therefore, we must engage with the meaning we’ve made from this routinized signing of the form. Does signing even realize any sort of comprehension of what is written or understanding of the possible implications?
I believe signing the consent form has turned into an implied process that comes with any medical procedure, and the consent form has lost explicit education and discussion about what consent entails. A signature no longer conveys a clear understanding of the facts of the procedure and the potential short term and long term implications. Therefore, I agree with you remarks on creating other solutions to the consent issue. I think medicine needs to return to personal interactions, and this could lead to the creation of a new job within our medical system.
I really liked how you delved into the idea of autonomy of the patient. I, however, looked more at the different sides in regards to the doctor. Having had to sit in a waiting room for immense amounts of time, I can clearly see the benefits of shortening the amount of time a doctor spends with a patient by cutting out the “unnecessary” information. Thus, the doctor would be able to see more patients within a day, which seems to be an indisputable positive. However, I find the idea of “unnecessary” information to be extremely subjective, as what you consider unnecessary may not be classified as such by another.
In addition, the internet hurts as much as it helps. After entering “symptoms: coughing, fever, and body ache”, webmd.com informed me that I was suffering either from the common cold,the flu, or perhaps chronic bronchitis. One always hears of how at ever slightest symptom, the internet diagnoses people with cancer. To some extent, it is important for the doctor to explain the likelihood of each outcome, lending this topic its obvious controversy.
This post brings up a lot of interesting and well-stated points. However, I think it is important to note that in some cases informed consent is not as cut-and-dry as it may seem. For instance, this might be a trickier area when the patient is slipping in and out of lucidity. I have also read cases where the family, for religious reasons or otherwise, did not want the patient to know the full extent of his or her illness. Issues like these make dealing with informed consent a little trickier, because what necessary constitutes informed, and who must give consent?
In response to you statement of, “How much information is too much”? I believe that there is a thin line in between how much information a doctor should disclose to the patient. How much do they want to know? The doctor doesn’t actually know what the patient doesn’t know already. However, even if the patient does have some knowledge of the treatment, it is the doctors job to ask about what they don’t know so they can fill in the gaps. I like the solutions that you have suggested, but i feel as though people wouldn’t pay as much attention to that either. Although, they would be help accountable for all the information that they did not read. Another suggestion could be informational videos concerning the treatment. Videos would make the situation more personal and less painful for them to digest the information and risks for the treatment.
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