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Residency
Insight
The Patient has Signed the Form,
But have you 'Obtained Consent' ?
Your hospitalized patient is on call to the
OR and you have just been paged by the nursing staff that there is no ‘Consent’
on the chart… Your attending is mad because the case is now being delayed and
the OR staff is anxious because they have a room waiting open. As you hurry up
to the patient’s room, your mission is to get the patient to sign on the ‘dotted
line’, but is this really what you should be most concerned about?
It is important to understand that “Informed
Consent” is NOT a piece of paper. In contrast, it is essentially an agreement
and understanding between the patient and their care givers that you have had a
discussion which provided them an understanding of the procedure and its risks /
benefits. The form which you complete is simply a way to legally document that
you have engaged in this conversation with the patient. This simple topic,
however, can quickly become a complex issue when you weigh in the medical
malpractice and liability concerns of our patient population. While I am
certainly not a lawyer, here are some common sense pointers to consider:
Avoid using abbreviations on the consent form.
Have a member of the nursing staff witness your discussion with the patient AND
their signature.
Obtain a Psychiatry consult if you doubt the patient’s competency to make his /
her own decisions.
Use non-technical terms in your discussion and on the consent form.
Always close with asking the patient if they have any further questions about
what you have discussed.
Be sure to include a discussion about what alternatives they might have to the
planned procedure.
There are numerous definitions of informed
consent and many can be easily found on the internet. One definition which I
believe summarizes this editorial and discussion is the following:
A person's
voluntary agreement, based upon adequate knowledge and understanding of relevant
information, to participate in research or to undergo a diagnostic, therapeutic,
or preventive procedure. In giving informed consent, subjects may not waive or
appear to waive any of their legal rights, or release or appear to release the
investigator, the sponsor, the institution or agents thereof from liability for
negligence.
Remember that in the courtroom, even the
‘perfect’ consent form doesn’t protect you from being sued. The key role of the
form at that point would be to document that you did not commit assault and
battery on the patient. I encourage you to seek out a legal expert at your
hospital who can come to one of your evening programs and discuss informed
consent further with you.
Any stories, feedback or
questions about informed consent?
Hear any nightmare cases about them? Please share your comments by sending a
note to
jsteinberg@podiatry.com
