Before a doctor ever lays hands on you or orders a prescription for you, there is a step that must be taken. Often it is not or it is done in a hurried, slapdash manner. That step is for the doctor to obtain your informed consent.
As you can see, there are two parts to informed consent. First, the patient must freely give his or her consent for the doctor to provide the recommended treatment. Secondly, the consent must be informed, which means that it should only be given after the doctor has explained both the risks and the benefits of the treatment.
Every medical treatment and every medication a doctor might prescribe has risks. Even everyday, over-the-counter products like aspirin have risks. Before a doctor recommends a course of treatment or a medication, she or he should conduct a risk/benefit analysis. Are the risks associated with the procedure or medication outweighed by the benefits likely to accrue to the patient? Unless the answer is pretty clearly a “yes,” the doctor should not proceed.
If the risk/benefit analysis concludes that the benefits outweigh the risks, the doctor should explain both to the patient so the patient can make an informed decision whether to go along with the suggested course of action or not. Unfortunately, this does not happen very often or happens in an abbreviated way. This is particularly true when it comes to prescriptions.
The doctor may tell you that she is prescribing a medication for you without ever discussing the consequences. I cannot remember the last time a doctor took the time to give me an in depth explanation of the possible side-effects or risks of a drug he was prescribing. They seem to expect this to be handled by the pharmacist filling the prescription. Not a good substitute. Prescribing without any explanation to the patient can be quite a problem, especially since the doctor may be receiving gifts or compensation from the drug company to prescribe the medication.
Things are a little better when it comes to surgical procedures, but not much. The doctor will almost always give you some information about what is planned and what are the alternatives. Even then, however, there are going to be lots of risks that are never mentioned. There is just no time in the current environment of short office visits to engage in a full and frank discussion of the pros and cons of a recommended operation. And, of course, how can you ask questions about risks you don’t even know exist?
Where you will likely find mention of all the things that can go wrong in the planned surgery is when you are presented with an informed consent document just before the operation. This document is not intended to inform you of the risks of the procedure, even though many of them will be listed there. The document is supposed to be an acknowledgement that your doctor has already explained all of this to you and answered all of your questions. This document just memorializes the earlier conversation, which may have never taken place, and will be shoved in your face if something goes wrong that you didn’t expect and that the doctor never mentioned when recommending the surgery. On top of that, the document is almost always presented to you by a nurse, who is not qualified or willing to discuss the surgical risks with you, if you have any questions.
Needless to say, when you are on the gurney just before the operation is to begin is not an ideal time for you to ask for a time out while you discuss the risks with the surgeon. The pressure is on and you are expected to sign the document and not gum up the works. And that is what always happens. Heck, most patients don’t even take the time to read the informed consent document with its list of horrors. They just sign where they are told to sign.
My suggestion is to do some research before the meeting with the surgeon. Look up the potential surgeries that might be recommended and their risks and formulate your questions. If you are not able to do that, don’t let the surgeon rush you. This is important. It is your body and you deserve a full explanation of what is being proposed and what alternatives there are to what is being proposed. Ask questions. Consider going home, doing the research, and then speaking to the surgeon again when you are better informed and better prepared to ask questions.
Make sure when you give consent that it is informed consent.
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