Friday, October 24, 2003

The ever-insightful Doc Shazam posted a comment to an earlier post....

.....For awhile, our IR (interventional radiology) guys were getting the ICU interns (primarily medicine, not surgery) to get patient consent for greenfield placement. Of course, the interns were not adequately prepared to obtain informed consent, most of us never having met any of the IR attendings. I obtained consent for one and felt like a fraud.....

And in doing so she made me think of another one of my pet peeves, physicians who (attempt) to get consent for procedures that they are not going to do. This is the difference between obtaining consent and obtaining informed consent. For example, a while ago a patient on the resident service at Big Hospital needed an angiogram to evaluate the arterial system in their legs to see if they were suitable for a bypass operation. The intern told me that he was going to "get consent" for the procedure and started towards the room..
ME: Are you doing the procedure?
DR. X.: No, sir. The radiologist is.
ME: Do you know the risks of the procedure?
DR.X: No.
ME: Do you know the alternatives for the procedure?
DR. X: No.
ME: Then why are you obtaining consent?
DR. X: (with a deer-in-the-headlights look) Ahhh,umm,errr... Feigns seizure. (Not really)
Informed consent is more than just a signature on a operative permit. It is an involved discussion outlining the indications for the operation, the hoped-for results, the complications that may arise (most of the discussion is about this), and the alternatives. This should be held between the operating surgeon and the patient. The example I gave was of misplaced good intentions, Doc Shazam's was one of simple laziness on the part of the radiologist.
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