Informed Consent

Failure to Rescue: The Story of Lewis Blackman

An Interdisciplinary Viewing

As a surgery resident, I had a different reaction to the the film “The Faces of Medical Errors…From Tears to Transparency: The Story of Lewis Blackman” than some of my fellow scholars. This is absolutely the value of viewing and discussing it in such a forum, as every perspective highlights specific opportunities for improvement.

As our interdisciplinary discussion highlighted, Lewis’ death was the unfortunate result of a broken system.  Lewis was a 15 year old undergoing a new repair for pectus excavatum.  The first systems issue brought up by his mother, who remains a strong patient advocate, was the informed consent process surrounding a new “low risk” surgery.  The pectus repair was technically successful, but issues started intraoperatively.  He was making minimal urine during the case and after.  He received multiple doses of toradol, up to post-operative day #5, with minimal oral… Continue reading

What is it that you want?

Today was difficult. Listening to how communication can go so wrong so quickly is intimidating. As a nurse, I thought healthcare allowed people to choose their desires. Michael and his family were never given that option. The neurosurgeon never gave them an alternative… he said this is what Michael needs to survive and that his family trusted that the neurosurgeon had Michael’s best interests at heart. I can keep going on about all the terrible things that happened, but I’m not.

We need to make a practice change. As a nurse, I’m going to start giving my patients the options to make more decisions about their care… and I’m going to start educating my patients on the healthcare system and what they can do to be informed. When I do an admission, I’m going to start asking them the tough questions- do you have a medical power of attorney?… Continue reading

That Creeping Feeling…

First of all, I want to say that Richard’s presentation was so phenomenal today. I distinctly remember hiking up the San Juan mountains in Colorado at last summer’s Telluride conference after a great session the day before thinking, “I’ve found my people.” It really is a special thing. I still see one of the other alums every now and then at hospital meetings and it literally warms my heart to hear his name and that he is doing great things at his home institution.

We talked a lot about informed consent and a patient’s understanding of their own experience in the healthcare system. As a primary care physician, I couldn’t help but wonder how Patty’s son’s primary care doctor felt about the horrific outcomes of his patient at the hands of a surgeon who probably didn’t need to operate in the first place, someone he tried to… Continue reading

Day 2 Reflection: Michael Skolnik and the problems we have with the process of obtaining informed consent

Today we discussed Michael Skolnik’s story and really touched on the process of informed consent. As a nurse I am a witness of informed consent and I have been identified by some as to “who not to ask to be a witness to an informed consent” form by some physicians in my practice. Often times, as many of the residents in the program identified, informed consent is one of the many tasks that physicians have to check off their list throughout the day. First off, I will not sign an informed consent if I was not in the room during the process of obtaining an informed consent. I also want to make sure the patient’s, or their families/POA, are able to state the procedure in their own terms, and every risk or benefit that accompany each procedure. If they cannot, I will have the physician restate or rephrase whatever part… Continue reading

Informed Consent and Shared Decision Making

Yesterday we began the morning by watching a film about Michael Skolnik, a young man who died from the aftermath of an unnecessarily aggressive brain surgery for what was ultimately an incidental imaging finding. This case highlighted several errors in the delivery of his care, but the most obvious was the absence of shared decision making. The Skolnik family was not given a complete picture of the risks of their son’s surgery as well as the alternatives available to them. Following the film we discussed several problems with the existing informed consent process. Many people noted that the current function of informed consent documents is to provide legal protection to the hospital and providers rather than truly inform the patient or obtain their consent in any meaningful sense of the word. Others noted the inherent conflict of interests that underlie the process: when hospitals and proceduralists rely on volume to… Continue reading

Day 2 Reflection: (Informative) Informed Consent

Just before coming to the AELPS conference in Napa Valley, I upgraded my cell phone. As I was setting up my phone, I hastily clicked through the buttons, checking the box to note that I had “read” the Terms and Conditions. Companies have gotten so used to their customers not reading these long Terms and Conditions that they don’t even show it to you during the main set-up; rather, you have to click on a link that takes you to a separate page to read them. Both the customer and company just go through this charade without a second thought.

While watching the film about Michael Skolnik, I realized that the “charade” feeling has permeated into our informed consent process. If healthcare workers minimize the process of informed consent to a mere formality, our patients will not be able to use that time to truly think about the risks, benefits,… Continue reading

Day 1 Telluride Reflection:

What a way to start a week! I had an idea of what this week would be like, but not to the extent of the material in which it would encompass. First thing this morning, we touched on a subject that hit so close to home: the difference between the thought processes and communication processes between nurses and physicians. The first activity of the day included a video of the Lewis Blackman story. There are so many events/problems that occurred between all interdisciplinary members of the team. One of the issues being that Lewis was not admitted post op to a medical-surgical floor for post-op management/observation; rather he was transferred to an oncology unit. No matter how we are trained, if we don’t regularly treat and manage a certain population, we need refreshers on what we should be looking for, and how to manage their care.

In the video we… Continue reading

Notes on consent form

I learned from today’s film that how conversation can save a life. Later on during the discussion section, consent form became a hot topic as it supposes to help patients making better decisions. Below I would like to share some information and thoughts that might somewhat help with the discussions over consent form.

1. Information representation and exchange

1.1 Problem statement

Data largely depends on paper-based instruments, which constraints data management and information exchange. My team members, during the discussion, expressed an interest in electronic consent; but view accurate electronic capture of informed consent data as a challenge.

1.2 Solutions

We need a medical coding system to define terminologies and semantic relations that are used in consent forms. This system can be something like Unified Medical Language System (UMLS, https://www.nlm.nih.gov/research/umls/). This system should be computer accessible and should be able to link to any existing medical language systems in… Continue reading

Can a conversation change an outcome?

Can a conversation change an outcome?!! This was the question that reverberated in my head after watching the video “The Faces of Medical Errors…From Tears to Transparency: The Story of Michael Skolnik”. It was painful to watch the story and see the pain in the eyes of the parents as they tried to relieve the whole ordeal. Across the room I could hear sobs and the expression of anger and sadness at the eventual outcome. A family had their son taking away from them.

As I engaged with my colleagues during the discussion, we were so quick to point fingers and express a disgust at the process that led to the outcome. However deep one, I reflect on moments when we walk into the room with “informed consents” with a sole purpose of getting a signature to legitimize our intervention, never giving the patient or family members enough time to… Continue reading

My evolution: Informed Consent

As a intern, the endless list of daily consents that I had to complete in the midst of the 50 other tasks, made it a less than perfect process. I celebrated that fact 90% of my patients signed on the dotted line no questions asked. The most common question: What time is my surgery?

As my consents became more efficient, it made room for a more thorough discussion regarding risks; an area I was to uncomfortable to delve too deeply into. The bear necessities to make it “real.” I celebrated the fact the 90% of my patients had no concerns. The most common question regarding risk: What kind of bandage will I have?

Today, when I consent a patient, I start by saying I want you to think of 2 or 3 questions before you can sign. And I take my time. I no longer have any anxiety discussing risks,… Continue reading

Telluride Experience 2020 Dates

BRECKENRIDGE, CO:
CMF Session One*: 6/8 – 6/11
Bennathan Session Two: 6/15 – 6/18
Session Three: 6/22 – 6/25

WASHINGTON, DC/MD:
Session Four: 7/22 – 7/25

*Session exclusive to the COPIC Medical Foundation Residents.