Thinking about informed consent
I dont think that I’ve ever thought so much about informed consent as I did today. I’ve always had the self-perception that I communicate well with patients, especially around planned procedures in the emergency department where I work. After today’s discussion, I recognize that I am doing a fine job, but I can also do so much better.
Informed consent is a shared decision making opportunity between patient and physician. At its core, informed consent is a conversation with the goal of allowing the patient to ask questions and hopefully come away with a clear understanding of the procedure to be performed, as well and the risks and benefits of the procedure. Procedures, diagnostic tests, and medications can all be conversations that are pursued with patients under the vigilance of informed consent.
While the conversation is the essential element of informed consent, the informed consent paperwork can serve… Continue reading
Patient-centered Care Education (Shared Decision Making)
Our second day in Marseille finished with the residents watching the award-winning film The Faces of Medical Error…From Tears to Transparency: The Story of Michael Skolnik”. The educational film addresses the importance of informed consent versus shared decision-making conversations – an important aspect of open and honest communication in healthcare that is still lacking in many health systems. The film asks the question – Can a conversation change an outcome? Can a conversation save a life?”
After the film, the residents engaged in a two-hour conversation with faculty and safety leaders on issues related to informed consent and shared decision making. When Paul Levy asked the residents how much training they get on this topic, every resident in the room acknowledged this three-hour session on informed consent/shared decision making was more education than they have received during… Continue reading
Skolnik Medical Transparency Expansion Bill Expands Information Available To Patients
On June 10th of this year, Colorado Governor Bill Ritter signed Senate Bill 124, better known as the Michael Skolnik Medical Transparency Expansion Bill, enlarging the circle of healthcare professionals in the state of Colorado that must make available all information related to their training, qualifications, criminal, disciplinary and malpractice history to healthcare consumers.
In 2007, Senator Morgan Carroll of Colorado, along with Patty and David Skolnik, championed the original Michael Skolnik Medical Transparency Act (HB 07-1331). This bill requires physicians in Colorado to report education, certain business relationships, malpractice involvement, and any disciplinary action or crimes. The bill is named after Patty and David’s son Michael, whose needless death at twenty-five years-old was the result of a surgery where related information was not disclosed to the family. Since Michael’s death in 2004, his mother, Patty Skolnik, has fought for greater transparency in healthcare. The expansion bill, passed earlier this… Continue reading
Visitors and Guests
In May, our newly appointed leader of CMS, Dr. Don Berwick, gave the graduation address at Yale University Medical School where his daughter was entering the ranks of newly anointed physicians. The graduation address has all but gone viral, making its way to those of us in Chicago so interested to hear the heart-felt health care experiences Dr. Berwick shares whenever he speaks. While the entire address was quite moving, what struck me most was the humility with which he views his profession, and his place within the circle of doctor-patient involvement. Here is an excerpt that I found particularly moving and speaks to the importance of delivering health care in a way that puts the patient first:
…What is at stake here may seem a small thing in the face of the enormous health care world you have joined. It is as a nickel to the $2.6 trillion industry.… Continue reading
Shared Decision-Making and Open, Honest Communication Change Outcomes
Rick Boothman sharing insights on open and honest communication related to adverse events.
What an amazing and invigorating second day of discovery and consensus building at our Marseille Roundtable on “Open and Honest Communication Skills in Healthcare”. The high altitude and beautiful mountain valley scenery have ways of opening up creative thought processes that lead to amazing new ideas. Some reflections from day two:
- Our second day focused on what patients and family expect related to open and honest communications in the domains of (a) informed consent and (b) when harm occurs from our care. Rosemary Gibson and Helen Haskell led the morning session which quickly evolved from the concept of informed consent to one of shared decision-making. David Longnecker talked about the “partnership” between patients and their caregivers when decisions on care need to be made and stressed that open and honest communication must go both ways in those… Continue reading