When I learned you can’t “go get” consent

Sometimes it is important to remember why I wanted to be a doctor. Don’t get me wrong, I love being a resident. I love meeting new people every day. I love the detective work in trying to figure out a diagnosis. I love teaching the students and junior house staff about various maladies. I love being there to help my patients through their illness. Yet, sometimes, it is easy to forget all of these things and focus on the negative. It is easy to be annoyed at the nurse for calling me about clarification of an order. It is easy to be curt with the pharmacist for questioning my dosing. It is easy to be annoyed at the patient for not taking his medications as prescribed. Today at the Telluride East summer camp, the chance to step back and reflect upon patient interactions was most appreciated.

Informed consent. All of these years, the true importance has been lost on me. Starting day one of my internship, I was expected to “go get consent” for this procedure or that transfusion. It was a task that needed to be done in a timely manner. It was a one page Fill-in-the-Blank paper. Often times, I was tasked with simply getting the paper signed. That was my goal. My goal was not to ensure my patient (and their family) had full understanding of a foreign (and sometimes scary) procedure. Often times, I wasn’t even aware of the alternatives, all of the risks, and all of the benefits. Yet here I was, making sure my patients were “informed.” I wasn’t even fully informed!

At no point did anyone ever stop and assess my ability to “get consent.” I had seen other people do it, so i parrotted what I had heard and seen. Again, my goal was to get this legal document signed as soon as possible so that I wouldn’t be holding up the next step in treatment.

In its present form, informed consent has morphed into this legal document that serves to protect the provider. The goal is to make sure everything is said out loud so that the patient can respond. After doing so, you can have a patient sign on the dotted line, thereby declaring for all to see that this patient is agreeing to treatment. Whether a patient truly understands the ramifications of a decision is not the point.

After our discussion today, my view of Informed Consent has greatly changed.

Informed consent, at its heart, is merely a term that has been placed on what we should be doing every single day with our patients. It is an invitation or reminder to have an open dialogue with a patient and their loved ones to provide transparency and open communication. It is an opportunity to assess a patient’s understanding of their illness and treatment plan and then meet the patient at their level. Questions can be asked. Ideas can be explored. It is a conversation that will hopefully lead to an agreement regarding a plan of treatment and next steps. Informed consent is a chance to divulge all of the options, explore them, and hopefully find an option that best fits the patients needs. It is not something that you “go get.”

I will take this idea back to my hospital and use informed consent as teaching points for both the junior house staff and patients. I also think that the essence of informed consent can be expanded to realms outside of the signing of a document. Specifically, it can be used as an opportunity to discuss medications with patients – for example, why I am prescribing an ace inhibitor. What the benefits are. What the risks are. What the alternatives are and why I am choosing it. This could be a great opportunity to engage my patients and improve their understanding of their conditions so as to hopefully improve compliance.

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