Treating Patients as Partners, by Way of Informed Consent

New York Times, By PAULINE W. CHEN, M.D., Published: July 30, 2009
http://www.nytimes.com/2009/07/30/he...r=2&ref=health

Pete looked away from me and stared at the consent form. Yet even as I watched his brows knit together, his eyes widen then wince, I kept on talking. I had gone into my inform consent mode — a tsunami of assorted descriptions and facts delivered within a few minutes. If Pete had wanted me to pause and linger over something, I never knew. He couldn’t get a word in edgewise.

“So,” I finally asked him at the end of my monologue, “do you have any questions?” Even as that sentence came out of my mouth, I knew what his answer would likely be.

Pete signed the consent. But as he took the pen to paper, I couldn’t help noticing the tremor in his hand and the pall that had suddenly descended upon the room and our interaction.

In the years since taking care of Pete, I’d like to think that I have gotten better at the process of informed consent. But every so often, despite what I believe are my best efforts, I feel myself falling back on old familiar patterns, habits I picked up not because someone taught me but because I never learned anything else. Like most doctors, I bumbled through each consent on my own, picking up certain phrases and dropping others through a sometimes painful and often awkward process of trial and error.

Thanks for this article, Stitcher. I hope it's appearance in the NYT will encourage many doctors to change their methods of presenting this info.

The worst example of it that I know of was when my father was hospitalized for a urological problem. The day before surgery his urologist met with the family in my father's room and explained all the basic options but required no signatures then.

At 10 pm that night, an intern came and presented the consent form and discussed more serious consequences and possibly more drastic surgery. He then required my legally blind father to sign the consent. It was certainly NOT informed nor was it signed with consent and my father was very upset with the lack of competent communication on the eve of his surgery.