After watching
the Michael Skolnik story here at Telluride, the residents and faculty broke into small groups to consider the issues involved in getting proper informed consent from patients who are about to undergo procedures. Faculty member Kim Oates later reminded the residents, "The consent form doesn't replace the conversation. And the conversation
is not a conversation unless it is a two-way conversation."
Although the focus was on the humanitarian reasons for engaging in proper consent procedures, faculty leader Dave Mayer also pointed out that informed consent breakdowns are a top
reason for losing malpractice cases. He also reminded the residents of the value of encouraging people to seek second opinions, not only for the patients themselves, but also for the doctors: "We’re all biased towards doing the procedures
we’re trained to do. If you think you’re
not, you’re fooling yourself."
Here's a composite of pictures of the members of one of the breakout groups .
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| Barbara Rubino |
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| Sam Kallus |
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| Julia Meade |
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| Jo Suh with Kim Oates |
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| Nick Clark with faculty member Carole Hemmelgarn |
Informed consent: if it isn't messy, you're probably not doing it right.
ReplyDeleteFrom Facebook:
ReplyDeleteI remember the days when an order was written in the chart for the nurses to obtain an operative permit. Doubt that was an informative conversation.
Paul you may recall that the ultimate choice point in my father's MRSA-precipitated death was all tied up, Gordian knot-like, in UNinformed consent—a phrase which I believe goes more to the heart of the consent issue. The work I subsequently engaged in to analyze all the failures (mine, my family's, medicine's) led me directly to a long examination of UNinformed consent and how overrides to patient-family directives play a, if not the, central role in the snafu. The number of entities potentially involved with invoking overrides includes patient-family, providers, institutions, and jurisdictions (the state). It's a complex, surprising, and troubling scene.
ReplyDeleteUnfortunately, the "signal" from malpractice liability exposure for failing to obtain informed consent is rather weak. But it is getting stronger.
ReplyDeletehttp://papers.ssrn.com/sol3/papers.cfm?abstract_id=2445440
From Facebook:
ReplyDeleteI have seen way too much "process trumps humanity" during the informed consent process. To teach a non-medical person the risks inherent in a procedure, without their basic understanding of 'medicine, nursing, etc.", takes time, patience and resources that, far too often, seem unavailable.
This is an area that can be greatly improved, needs reimbursement and may even need a specialist- a procedural facilitator- who can take technical 'medicalese' and bring it to the common person...sounds like a nurse ;-) but even we are pressed for time, limited in scope and when assuming a patient advocacy stance (ie, this patient doesn't understand what they are about to undergo, we need to re-teach) is a great risk of "offending a surgeon" (which may have been the 11th commandment?) and termination for "doing the job".
Thanks for bringing this up for discussion, Paul, we all deserve better regarding this issue, the patients, the providers and the hospitals.