Informed Consent in Residency and Practice

Without a doubt, the medical-legal aspects of daily practice can be some of the most frustrating and nerve-racking challenges we face.  As a resident, you will likely be asked to ‘fill out the consent form and get the patient to sign it’ before surgery.  While an attending surgeon must be involved in the consent process, it is perfectly acceptable for residents to assist in this task and therefore you should have the proper resources to do it properly.

One common error when obtaining consent is to focus on the sheet of paper rather than the discussion and actual patient education.   

Some key pointers to follow when assisting with or obtaining informed consent from a patient:

1. Keep in mind that informed consent is NOT A PIECE OF PAPER, rather it is a discussion and understanding between the patient and provider.  The piece of paper is simply a tool to document that this discussion occurred.
2. Do not use abbreviations on the form.  (this includes L or R)
3. Use common terms and language to explain the procedure, risks, benefits, and alternatives.
4. Be aware of your institution’s restrictions on how long a consent form is good for…ie. don’t do it too far in advance of the scheduled procedure.
5. In court, a consent form will rarely help you, but if you don’t have one it will most certainly hurt you.
6. Informed consent is generally required for:
   1. Performance of surgery, including the related administration of anesthesia.
   2. Administration of radiation or chemotherapy.
   3. Administration of a blood transfusion.
   4. Inserting devices and/or appliances under the skin.
   5. Administering experimental devices or medication.
7. A summary of the key elements for informed consent are:
   1. Explain generally why the operation or procedure is necessary and how it is to be performed.
   2. Explain the alternative treatments available to the patient and why the surgery or your treatment is recommended.
   3. Explain the likely result of the procedure, trying not to alarm or mislead the patient.
   4. Explain the material risks of the procedure.
   5. Explain to the patient what to expect during the recovery period and hospitalization.
   6. Explain any other residual effects from the procedure.
   7. Encourage and welcome the patient to ask questions.
   8. Document these discussions

If you are organized and directed in your presentation / discussion, the above task list can be accomplished in a reasonable amount of time.  It is imperative that your patient be comfortable with the procedure and properly prepared for the post operative course.

Have a great week !