One Dozen Things
Informed Consent
Scenario Analysis
This scenario is meant to portray the proper way to obtain informed patient consent. The patient is being evaluated for a headache, has had a negative head CT, and the doctor feels the next appropriate step is to perform a lumbar puncture.
The doctor begins by interpreting and explaining the negative findings on the CT. He then goes on to explain the possible diagnoses that concern him the most. Although he does use a medical term, he immediately explains it in a way the patient can understand.
He explains the procedure, what information it may yield, and the possible risks and complications associated with it. In response to the patient’s question about other alternatives, he indicates that there are other diagnostic options but explains why they would not be appropriate at this point. He very directly and honestly responds to the patient’s concerns about the cost of the procedure and how painful it may be. He concludes by asking the patient if he understands what is happening and if his questions have been adequately answered. When he presents the patient with the consent form, he urges him to read it carefully before signing it. He also is considerate enough to be sure that the patient has adequate light to do so.
This physician’s approach to obtaining informed consent is characterized by complete and clear explanations of potential diagnoses, results of studies done so far, and the rationale for pursuing further workup. He describes the proposed procedure in understandable terminology, acknowledging possible complications and risks. He also indicates other diagnostic options and explains why they would not be as appropriate.
The conversation is not rushed. The patient has ample opportunity to ask questions. Information is provided in a straightforward and clear manner. Before presenting the consent form, the physician checks the patient’s understanding of the situation and what is about to be done and invites additional questions. Finally, he encourages the patient to read the consent form before signing it.
These are some of the hallmarks of properly obtained informed consent. Some might also suggest that the patient should articulate in his own words his understanding, but this may not be essential if it seems clear that he does understand.
Obtaining informed consent can be time-consuming and often requires a special effort to be sure information is being presented in a way that the patient can understand. It may be particularly challenging in situations where the patient is in pain or urgent intervention is necessary, but, even then, proper consent must not be compromised.
