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 of the procedure the patient or their families did not understand. Another issue we must consider is the emotional state of the patient or family when obtaining the informed consent. Anytime a patient is in the hospital, they or their families are scared. When they are scared they are not able to comprehend everything that is being said to them. We must remember to put ourselves in their shoes.

I’ve also never thought of asking what is the goal of care of the patient during the informed consent process. I believe that this is a crucial time to understand where the patient see’s themselves, after benefitting from whatever we are offering that we believe is to be in their best interest. Do we also give the patient or whoever is designated to make this decision for them enough time to think over the procedure and the risks/benefits involved.

During today’s lesson too, I also learned about parts of the informed consent that we definitely overlook. I often hear physicians talk about what could happen if we do not perform a certain procedure, but I almost never hear them talk about alternative methods or alternative courses of treatment that are available. Nor do I hear them ask about a second opinion. Is it due to the standardized process that informed consents are being processed and pre-printed for certain procedures? Does this inadvertently encourage physicians to rush through every detail, every risk/benefit and alterative options that every procedure has to offer? Having the privilege of working at a huge organization, it is so easy to get a second opinion, but how often do we offer a second opinion? Do we provide the patients and their families with all the rights that they have during the course of their hospital stay? I want to look into ways we can better educate patients and their families about how they can better advocate for their care.

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