If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes.
Is this proper informed consent? Yes, and no.
Potentially yes, if all the appropriate alternatives to treatment, the likelihood for success, plus the risks and the benefits were detailed. No, in that there is no way to have the discussion in a matter of minutes and for the patient to understand all the language. Ultimately, does informed consent protect the patient, or does it protect the physician and hospital from liability?
For the most part, the answer is the latter.
By signing an informed consent form, say to have your appendix removed, the document can be a barrier to being successful with a medical malpractice claim. Though, if your surgeon was truly in the wrong, you can still sue your doctor for negligent or intentional wrongdoing regardless of your signature. On the flip side, there could be a medical complication (for instance, a post-op infection), but you acknowledged this risk upon signing. Could you still sue in this case? How can this issue be avoided?
In short, you must always be proactive in your care. More often than not, patients will defer to their physicians when it comes to medical decision making. “You’re the doctor, tell me what to do.” “I trust your recommendation, doc.” “I don’t know whatever you decide.” As a medical student, I’ve sat in on many informed consent sessions where patients rarely asked questions. I remember a time where a patient told me he felt compelled to sign the consent form because his surgeon expressed the benefits in such a positive light and was cursory with the risks. Affirmative head nods abound, and within minutes the patient put pen to paper.
To be an active participant in your health care, you should seek clarification on terms and phrases that you don’t fully understand. The questions “What has been your own experience with past patients who had this procedure? Were they satisfied with the outcomes?” are essential to ask your physician before deciding. I had a patient a few years ago who asked her surgeon these questions, and the surgeon proceeded to provide more insight into the operation that he otherwise would not have shared had he not been asked those questions.
As well, when your doctor finishes speaking, it is good practice to summarize back the main points of the conversation. This is important because if you accurately understood what your physician told you about the surgery, you will be able to repeat back to your doctor in your own words. If you are unable to, this will tip your doctor off that he/she needs to explain better what you were not able to summarize. This, in turn, makes the informed consent process more complete.
What’s more, patients who are not well educated and come from lower-income families are the most vulnerable because they do not understand what they are consenting to. This fact is highlighted by informed consent being given, for instance, to Spanish speaking patients via a phone translator as the middle person. Words can be confused, consent takes longer than what the resident wants, and everyone gets frustrated.
The best solution is for the patient to request an in-person translator because communication is incomplete when it is conducted over the phone. When there is a phone translator, the resident rarely makes eye contact with the patient, but instead, their eyes are glued to the speakerphone (and vice versa). By having an experienced in-person translator, the doctor and the patient engage in a back-and-forth conversation as the translator helps bridges the language divide. Awkward silence is the norm for phone translation discussions; that is not the case when everyone is physically present in the same room.
Ultimately, it comes down to shared decision making between patient and doctor. A patient comes to the hospital with their lifetime of experiences with the health care field (or lack thereof), and doctors must be cognizant of this fact. Doctors, no matter how demanding their schedules are, should take time to build rapport with their patients to better understand their motivations, their hopes, and why they came to the hospital at this moment in time. If you see that a resident is rushing the informed consent process, ask that more time be taken because it is important to you to comprehend what’s being said before coming to any decision. No one has the right to rush you because medical decisions made without enough forethought carries an unnecessary level of risk.
Likewise, if you ever find yourself in the hospital, ask your treatment team questions. If you have trouble coming up with questions, have a friend or family member with you to help. If the resident doesn’t have a concrete answer, ask for the attending’s opinion. If you are not vocal, then your doctors will assume that you are OK with any decisions that they make on your behalf. The worst-case scenario is when you give informed consent for some medical protocol to only later regret the outcomes because you did not fully understand the ramifications, the risks, and the alternatives. By then, it is too late. Always remember that you are the most essential part of the health care team.
Ton La, Jr. is a medical student and can be reached on LinkedIn.
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