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Friday, December 26, 2008

Patient Consent Update Needed Now

The following two paragraphs come from the January 2008 issue of my newsletter, herbalYODA Says!

"herbalYODA Says! Volume 5, Number 1 – January 2008

The Importance of Informed Consent

Informed consent, according to the University of Washington's School of Medicine, "is the process by which a fully informed patient can participate in choices about his/her health care. It originates from the legal and ethical right the patient has to direct what happens to (their) body and from the ethical duty of the physician to involve the patient in (their) health care."

Informed consent is the cornerstone of ethical conduct in health care. Written consent does not take the place of a patient fully understanding a proposed drug or treatment. Rarely does a person who may have language or illiteracy concerns receive the clarification necessary to understand what it being prescribed or proposed as treatment. (more...)"

I am a staunch supporter of and educator about informed consent. This doctrine is required for any and all medications, treatments, surgeries or tests ordered for you by your health care provider.

The pure reason I am such a stickler is that year after year I find that very little of this process is going on, at least at a level a patient would understand.

The blank stares I get when I ask people about drugs that have been prescribed are telling enough.

The problem, as I see it, is that this is an all too common practice, and a practice that ultimately gets everyone in trouble.

For the very reason that is stated in the title, this article addresses the critical issue, education. I have to agree that is is well past time that not only consent forms, but the consent process come back into vogue.
Patient Consent Forms Should Educate Not Intimidate, Experts Urge
ScienceDaily (Dec. 24, 2008) — It’s time patient consent forms came back full circle to a tool for patient education, rather than the waiver of liability they have become, experts urge.

The original purpose of the consent forms was for a surgeon or doctor to inform the patient of common or serious risks associated with the procedure to be performed. However, the way current consent forms are written – as formal, legal documents – plants a litigious relationship in both the patient’s and the surgeon’s mind even before treatment has begun.

Lawrence Brenner is an attorney on the faculty of the Department of Orthopedics at Yale University. He and his colleagues propose a set of five recommendations to return consent forms to their intended purpose – that of allowing patients to meaningfully take part in the decision-making process. Their suggestions have been published online in Springer’s journal, Clinical Orthopaedics and Related Research.

As surgeons have become increasingly concerned about potential litigation, the informed consent process has lost its educational value. The focus is now on obtaining ‘preoperative release’, rather than an exchange of information to help patients make important decisions about their healthcare choices. In reality, the majority of patients find it a challenge to understand the complicated legal jargon used on the forms.

Research also suggests that proper informed consent has a direct impact on the quality of patients’ recovery after surgery. Indeed, patients have more realistic expectations and are better prepared psychologically to cope with the outcome of the operation when they have had an open discussion with their physician about what to expect during and after surgery.

In order to return informed consent forms to a tool for patient education rather than a form written by lawyers to absolve surgeons from liability, the authors make five recommendations. First, the informed consent form should never be viewed as a substitute for educating the patient; it is merely evidence that an appropriate discussion has taken place. Second, the forms should be designed to be understandable. Third, surgeons should not be afraid to communicate uncertainty in order to have a truly open discussion with their patients. Fourth, patients need to be active participants in the dialogue about the potential risks of the procedure. Finally, a note by the surgeon in the patients’ medical notes, that states that a discussion has taken place, is likely to be much more effective than a lengthy signed, but incomprehensible, form.


Journal reference:

Brenner et al. Beyond Informed Consent: Educating the Patient. Clinical Orthopaedics and Related Research, 2008; DOI: 10.1007/s11999-008-0642-4

Springer (2008, December 24). Patient Consent Forms Should Educate Not Intimidate, Experts Urge.

ScienceDaily: /releases/2008/12/081217124158.htm

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