Informed Consent is the Law: Stop, Talk and Show Should be the Standard

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A lot of us think of “informed consent” as just a form the doctor’s office has us sign. The forms are usually full of really broad, overreaching phrases like “all reasonable medical alternatives were fully and completely explained to me, and I understand that this surgery/ procedure has the following risks . . . .etc. etc.”  And too often, patients are given the forms and expected to sign them without really having any idea what they are signing and what the forms mean.

This sort of “dotting the  I’s and crossing the T’s” approach does little to form a complete sentence, and it does little for the patient or the medical profession. So before you ever sign an informed consent, you should have had a thorough, two-way dialogue with your doctor.  And you should push for a STOP, TALK, and SHOW approach to understanding your condition, your diagnosis, your options, and the risks associated with each and every option—including the option to get a second opinion or forego any medical treatment at all.

Most people don’t know that they actually have specific legal rights that entitle them to have a thorough and informed discussion prior to any non-emergency medical procedure.  Just from an ethical standpoint, doctors should be eager to have that discussion too since that discussion really is the backbone of a meaningful doctor-patient relationship.  But regardless of whether the doctor is eager to have the discussion or is eager to march forward with the procedure, most states have a statute specifically requiring health-care professionals to obtain informed consent, and most states set forth standards that the medical profession should meet in order to show that the patient was informed about the procedure, its risks, and the alternatives to the procedure when he/she consented.  Some states look at these talks from the viewpoint of the doctor: Would other doctors in the same position say the doctor gave adequate information to inform the patient? Other states take a more patient-centric view: Did the doctor tell the patient the things a prudent patient would want to know?

Regardless of where you live and regardless of the standard that particular state sets, I suggest you adopt a “STOP, TALK, and SHOW” requirement yourself before you consent to any medical procedure.  And if you are like me, you’ll want to be heavy on the SHOW part of the discussion.

STOP – As soon as the doctor suggests a plan of treatment, stop the doctor right there, take out your notepad, and get ready to jot down everything the doctor says so that during the next section, the TALK section, you can make sure you talk about everything the doctor just breezed through.  (And understand, I don’t say “breezed through” to indicate a lack of concern or rigor on the part of the doctor. This is his/her area, and it’s not uncommon for people with highly specialized sets of knowledge to sail through a topic that we ordinary people don’t fully understand).

TALK – Once the doctor has finished with his “plan of treatment” discussion, it’s your turn. You have to look at this conversation for what it is: your best opportunity to make the best decision for your health. So talk to the doctor until you understand the following things:

  1. What is the condition the doc thinks is creating your symptoms/complaints?
    1. This one requires that the doc explain what condition/injury/or disease process is, how it works, and why it is the most likely cause for your symptoms and complaints.
    2. This one also requires the doc to tell you how he ruled out other possible causes of your symptoms/complaints.
    3. If the condition is one that was diagnosed by x-ray or MRI, it might be a good opportunity for the doctor to SHOW you what the condition is.
  2. What are ALL of the available treatments for this condition, and what are their concordant risks?
    1. For most conditions there are multiple accepted ways of treating the condition.  You’re entitled to (and the doc is required to give you) an explanation of these alternative treatments.
    2. You are also entitled to know the risks of the alternative treatments.  The doc may have ruled out an alternative treatment because it is less effective, but if it has lower risk, you might want to try that treatment first.
    3. When the alternative treatments are surgical in nature, the doctor can often draw out the procedure so they can SHOW you what is being proposed.  Despite their infamous handwriting, most doctors can draw out a simple surgical process so that you can see what you’re getting into.
  3. Which treatment does the doc recommend and why?
    1. You should have gotten this information along with the alternatives, but since this is the proposed treatment, you are likely going to hear more about its strengths than its weaknesses.  This is a good time to fully understand how the procedure works.  Many times a surgeon will draw out his proposed approach—ask for the drawing.
    2. This part of the conversation should be clear enough that you can intelligently compare the alternatives.  If you feel like you’re in a car dealership making choices before the “boss in the back” leaves, you aren’t having the proper interaction.
  4. What are the risks of the proposed treatment?
    1. I separate this part out because the informed consent forms generally lay these risks out in black and white and they might be vastly different from the conversational risks you were told about.
    2. I ask the doctors to go ahead and SHOW me the informed consent form at this stage so that I can compare the written risks with the risks we’ve discussed.
  5. What are the risks of the alternative treatments?
  6. What are the risks of foregoing any treatment at all?

If this seems like a lot, it is. But remember, you are entitled by law to be fully informed before you have a medical procedure.  Some doctors and hospitals are so focused on meeting quotas and “staying on schedule” that they will try to satisfy that right by giving you a piece of paper and expecting you to just go along with their expert decision about how to manage your health.  The STOP, TALK, and SHOW approach will help you understand the procedure, but it will also help you gauge which doctors see the doctor-patient relationship as a profoundly important part of health care.  I submit that the doctors who take the time to explain the procedure well will also take the time to perform it well.

STOP, TALK, and SHOW, I’d love to hear how it works for you.

 

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6 Comments

  1. Kay Grace – I just saw your comment. All your points are “dead on.” And based on my experience and connections with so many women who were over-treated by gynecologists, not only do they tend to omit information, they exaggerate (and even lie about) the need to move forward with treatment.

    For many women, these are doctors we’ve trusted for many years who’ve seen us through pregnancy and childbirth. This has a way of clouding our judgment. And with the push to see a gynecologist yearly and them being surgeons, we’re “sitting ducks” for over-treatment.

  2. This sounds wonderful, but in the real world this just does not happen. One doctor fired me for asking too many questions (first time having any surgery of any kind and I had plenty of questions)and refused to allow me to record the appointment. My surgeon told me to ‘go home and Google it’. My last appointment she refused to answer a single question, simply gave me the names of two doctors I could consult for further surgery(what she did failed), gave me the bums rush and charged me $110.

    And even if you do get them to answer your questions how do you know they’ve told you the truth – the whole truth? And how do you know what you don’t know?

    It’s been my experience that they only tell you what they want you to know in order to get you to make the decision they want you to make.

  3. WS,
    Thanks for the kind words, and yes, it is tough to tell if the doctor is telling the full truth about the procedure, the medications, the prognosis etc. (or if he/she even knows the full truth). I wish there were a single fix that I could offer, but there isn’t. Being vigilant about your health, becoming informed about the issues surrounding your health, taking control of the discussions that concern your health, and getting second opinions before committing to a course of treatment might be the best that we can do. I am encouraged by the number of people who take the time to comment on these articles, and I am encouraged that communities like the one here are being created. It really shows that people are trying to take control of their health and are trying to offer help to others doing the same–the kernels of a true community.
    Best,
    Phil
    Docnosis.com

  4. Thanks for this article. These are all good tips. But the patient can’t know if the doctor is telling him/her everything about the diagnosis and treatment options. And informed consent is nearly impossible to prove so patients are left without recourse.

    Informed consent is a HUGE issue for gynecologic surgeries especially hysterectomy and female castration. Yet, they’ve made these surgeries a sort of “standard of care” so it’s impossible to sue (for the harm caused) much less sue for lack of informed consent.

  5. Danny, I don’t know of any way to make the doctor sign the pad for you, and different states have different laws concerning “recording” conversations. In Florida, making an audio recording of the meeting would be illegal without the party’s consent.
    Thanks for the kind words, and I hope the STOP, TALK, and SHOW approach proves helpful to you.

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