Within the last generation, the idea of informed consent has swiftly grown in the eyes of the public. While many scenarios focus on the repercussions patients face due to insufficient information, there have also been negative ramifications that have implicated doctors and other health care providers. These professionals face questions like how much information must they provide? How much is too much or too little information? Do information sheets and relevant websites count as the doctor informing the patient, or must certain ideas be specifically vocalized? Within this post, what is not necessary and what is necessary for a doctor to discuss will be analyzed.
The courts of Australia and Great Britain have h eld that when disclosing information, they hold “therapeutic privilege. ” This therapeutic privilege justifies “withholding information that may harm a patient” (Informed Consent: a Lesson from Australia). While at first glance this seems to be protecting a doctor from having to disclose information about heart surgery when the patient is facing a cold, this actually branches out to include a doctor not needing to discuss heart surgery for someone who would be harmed by it, even if they had a debilitating heart condition. In that particular situation, however, a doctor would probably mention the idea of heart surgery, but then clearly explain the risks associated with each particular scenario and offering their own advice as a trained health professional.
On the other hand, when communicating information to the patient about a treatment, doctors should avoid words like “small risk, slight risk, and rare”, as these terms are extremely subjective. Rather, the risks should be discussed in terms of percentages and other numerical ranges that can clearly communicate the actual statistics of the procedure or medication. In addition, a risk does not necessarily have to be life threatening to be disclosed. In “Informed Consent: a Lesson from Australia”, the example of the risk of “faeces leaking into the vagina, which is unpleasant but not life threatening” is one that should be communicated from the healthcare provider, to the patient. The article then goes on to explain that these sorts of potential risks must be clearly communicated by vocalization. It is not enough to simply “providing pamphlets about a proposed procedure”. Holland follows a similar line, explaining that the doctor must “tell” the patient the facts and risks in the form of a clear story (Holland 334).
Overall, there should be a legalized consensus as to what required of a doctor. If there was a chart while demonstrated as to when what information is necessary to be available to the patient, the healthcare provider would simply need to inform the patient based off of the circumstances that have been precedent. Until this clarification has been made, it is vital for the doctor to impart all relevant information, as it is better to over-inform rather than under-inform.
Source:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121943/
Actually, it may not always be better to over-inform. In the abstract of this article I found, you can read the many negative aspects of shared decision-making. If the doctor shares too much information, providing too many options for treatment, it could distract from the best possible treatment option- sometimes the only option that a doctors sees fit. On a bigger scale, sharing worse/alternative options can “lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.” I can imagine this scenario applying to somebody with tennis elbow- the treatment options could be rest/ice/NSAIDS, surgery, or steroid injection. Steroid injection is the easiest option with the quickest positive results. The doctor makes more money by recommending steroid injections rather than recommending a more natural, slower healing process involving rest/ice/NSAIDS. As a result, the patient may overuse steroid injections, which could potentially cause irreversible damage to the tendon. If the problem gets much worse, the patient would go on to surgery. However, the high healthcare costs of steroid injections and surgery could have been avoided if the patient stopped the activity that was causing overuse, and used rest/ice/NSAIDS, a low-cost (or even free), effective treatment.
Coulter A. (1997). Partnerships with patients: the pros and cons of shared
clinical decision-making. Journal of Health Services Research & Policy, 2(2), 112–121. Retrieved from http://hsr.sagepub.com/content/2/2/112.short.
I agree with Jackie’s comment that it is not always the best option to over-share; however, this can cause legal implications. An example in which the physician should not over-share is if there was a patient fearful of many side effects in general, and perhaps one was minutely association with the procedure. If this was a life or death situation, then the physician should under-share in order to guarantee that the patient follows through with the procedure and has the chance at staying alive. If the over-sharing led to a patient’s refusal of life saving treatment, then it should not have been done. The only conflict about this is that if a patient is not fully informed their decision might not be entirely autonomous, given that they do not necessarily know what they are getting themselves into. I do understand the argument that over-sharing is safer because this prevents legal disputes and promotes patient autonomy. However, in my opinion the costs of over-sharing outweigh the benefits because sometimes too much information can cause the patient to make an irrational decision not reflective of what is best for them.
I think there are certain circumstances when over-sharing is okay and when over-sharing is not. I agree with Jackie’s comment that over-sharing treatment options may not be beneficial for the patient because it can lead to unnecessary procedures. The doctor should share the treatment options that he/she thinks is medically best for the patient. On the other hand, there are some situations in which over-sharing might not be a bad idea, such as sharing life-altering side effects. Personally, I would like my physician to tell me that a treatmeat might cause “feces to leak into the vagina” because that can possibly led to vaginal infections. Although, such a disclosure might cause someone to change their mind about a treatment, I think it’s still important to tell patients so that they’re not confused when they suddenly find feces leaking into their vagina. It’s up to the patients to rationalize what they think is best for themselves after the physician provides them with medical advice.
I definitely agree about the idea of over-sharing having negative consequences. While I understand that the legal implications promote the idea of over-sharing, this should not be the main concern for the physician. The best treatment and well being of the patient should be the most important concern for the physician, not will I get sued or how much money can I make. Thus, physicians should give the patients the level of information and details necessary for them to understand their options and the implications of their options. Furthermore, the doctor should give his recommendation and explain the reasoning for suggesting that treatment over another treatment.
On another note, I think that physicians need to strategically place where in their explanation they mention the risks. Often, a risk can sound much worse than it actually is, especially when placed with other risks. Physicians need to think about how their speeches about the treatment options and risk sound to a patient who is already scared and unsure of what is happening to them. Ultimately, doctors need to evaluate when and how much information to share on a patient by patient bases.
I thought it was interesting that you brought up the medical system of other countries. I, especially, was interested in your comments about Australia because I hope to be studying there next semester.
Anyways, I disagree with your last point that it’s better to over-inform then under-inform. Your point about Australia’s system holding back information that may be harmful to the patient contradicts your last statement. Like Australia’s system, I also think that too much information could be harmful for the patient. Because there’s a language barrier between doctor and patient, there may be things that doctor says that the patient completely misunderstands. This confusion could cause the patient distress due to uncertainty.
Though I think it’s dangerous to over-inform, it’s also dangerous to under-inform. Informed consent is extremely important because the patient has the right to know his medical conditions.
I find it interesting how you brought up the healthcare system in other countries that accept with-holding information from patients for ‘therapeutic privilege’. By using this system, physicians are not providing the opportunity for autonomy for their patients. I believe that it should not be up to the physician to decide what is best for the patient. Some people may make what appears to be irrational decisions, but these decisions are logical and reasonable to them.
I agree that certain terms are subjective, and percentages should be used, but sometimes real numbers have more of an impact on people than just percentages. For this reason, I feel that real numbers, not percentages, should be used.