One of the highlights of the Telluride Patient Safety Summer Camp was the in-depth discussion of the meaning of informed consent. It is not as straightforward as “here, sign this”. In fact the paper consent itself is in a sense the last and least component of informed consent. I was a bit surprised and secretly glad to hear some places have rid themselves of the informed consent form, which reinforces the notion that informed consent is some kind of administrative scut to be dished out to residents. Informed consent isn’t extra, it isn’t something for special procedures, it really should be an integrated part of every doctor-patient relationship. The heart of it is shared decision making and coming to the best course of action based on the patient’s preferences, values, needs, and goals. (“Preferences, values, needs, and goals” was in fact one of my takeaways – a mental checklist… Continue reading
The word preventable can be misleading. It may imply that preventive perfection (zero harm) is possible. It does imply that some things are not preventable; sometimes these harms are distinguished by the label “complications”.
I like to take the view that all harm is at least to some extent preventable, and that there exist ways to minimize the risk of any given harm associated with any given procedure. It is a continuum. Sometimes, as in with central line infections, we have highly effective methods to minimize the risk, and then we label and declare all central line infections preventable. Other times we honestly don’t have methods to reliably minimize risk for a particular harm, and we do not consider it preventable. In these cases we declare the harm to be an unpreventable complication, i.e. “these things happen”. An example of this would be central line infections…15 years ago. I would… Continue reading