Components of Informed Consent
1. Before patients can give consent to be treated by a physician, they must be informed of and understand the health implications of their diagnoses.
2. Patients must also be informed of the health risks and benefits of treatment and the alternatives to treatment.
3. Patients must know the likely outcome if they do not consent to the treatment.
4. They must also be informed that they can withdraw consent for treatment at any time before the procedure.
5. Physicians must also obtain informed consent prior to entering a patient in a research study. However, if a patient’s condition worsens during the study as a result of lack of treatment, placebo treatment, or exposure to experimental treatment, the patient must be taken out of the study and given the standard treatment for his or her condition
-Behavioral Science, 5th Edition
Barbara Fadem, Ph.D.
The last time you went to the Doctor and were prescribed a medication, sent on a treatment plan, or given counsel about your lifestyle, you were likely informed of the benefits. Were you informed of the risks? Likely not. See, that’s the issue. Many Doctors today are in a hurry, and neglect to fulfill these important aspects of informed consent simply because time doesn’t permit. But is that really a decent excuse?
As clinicians, our duty is to our patients. Over all, their health is our top priority. However, the patient has full right as to what happens with their body, and rightly so. Our duty is to provide them with the knowledge they need to make an informed decision about their health, our recommendations pertaining to it, and any other choices that may have cropped up in their daily lives. In order for a patient to be truly informed, and thusly able to make that important decision, they need the unbiased factual knowledge that is currently known about the choice at hand. This is where personal biases and lack of knowledge (and sometimes sadly, laziness!) come to play. These forces, acting in concert, undermine the purpose of informed consent, and turn it into little more than a blurb to be tested on in relevant ethics sections of exams.
Pills, Thrills, and Shills
Obviously, one of the biggest parts of the Doctor/Patient encounter is the prescription of drugs for any wide variety of conditions. It’s no doubt exciting to the new doctor (speaking as a medical student) and probably hum-drum and dull to the experienced Physician. But, whether you are a green-horn intern raring to go, or a battle-hardened Attending who waxes poetic about the “good old days”, the same policies and principles apply.
When prescribing a patient a drug, you NEED to talk to them about it. Outline WHY you are prescribing it, what the drug does, and what they can reasonably expect from it. This data should be gleaned from not only your knowledge of Pharmacology, but from the research you have done into the drugs you are desiring to prescribe. This entails reading *gasp*, Medical Journals! Keeping up on the literature is key, and serves to better inform you. Because let’s face it, institutions are slow and resistant to change. The drug du jour for a specific condition may not be the drug you are told to utilize by your institution, or your peers. When facing these discrepancies, you need to be informed so that you can take these concerns to the proper committee.
The patient also needs to know side effects. What are they, which ones are common, and again, what can the patient reasonably expect. This information is not difficult to obtain. It’s available via the classic Physician’s Desk Reference, or for the Tech-Age people among us, on programs like Epocrates on a smart phone.
A lot of people say “That takes too much time!” and yes, it does take time. However, that’s your DUTY to your patient. You make the time. You entered this career for a reason. Don’t forget that reason because you are tired, annoyed, overburdened with work from your Resident, or feeling lazy.
Supplements/Complementary and Alternative Medicine (SCAM) or: How I learned to stop worrying and trust the Science
As many of you know me well, you know I’m a staunch advocate of science-based medicine. This means only recommending or endorsing treatment options based on positive evidence from randomized, double-blinded, placebo-controlled studies. Medicine is a lucrative field for both Pharmaceutical Companies and “Alternative” Peddlers alike, and both will resort to trickery to try and take your money. However, while the marketing teams and corporate lawyers of Pharmaceutical Companies are crooked, their science is not. They have the benefit of reproducible, peer reviewed studies to back their claims. The drugs might cost too much, but they work.
“Alters” on the other hand, don’t have this luxury. They have to resort to testimonials from patients or celebrities, which are not valid evidence of anything. Along with this comes our duty to the patient, and informed consent. If a patient wishes to undergo an alternative therapy, I believe it’s our duty to inform ourselves about that therapy, study the claims of efficacy, and inform the patient of the side effects and likely outcome. Just as we would for any “conventional” drug or therapy.
If you want to try acupuncture, fine. But I’m duty bound to inform you that it’s been extensively studied and shown to have zilch on the way of effects greater than placebo treatment with sham acupuncture. I also should be informing you of the risks of infection (This IS an invasive procedure utilizing needles penetrating the skin!) as well as the reports of collapsed lungs and death. These are all very real side effects that have been documented extensively, yet most alt-medders tend to gloss over them without much thought, while yammering on about how terrible our pharmaceuticals are. However, with that information in mind, if the patient still wants to try, then that is their right, period. You’ve informed them of the necessary information, and they made an informed decision. Your job is done.
Conclusion
Above all, work with your patient. Develop a rapport with them, be understanding, and address their concerns. The above example may seem draconian to some, but delivered with tact and compassion, it’s very likely to work. You’ve done your job, the patient is informed, and is free to exercise their right to choice. Everyone wins, and everyone benefits.
It is in this way, Physicians don’t have to support quackery and health fraud, but can avoid alienating their patients.
