In the contemporary practice of medicine, informed consent is, first and foremost, an ongoing process or dialogue with patients. It is not simply executing a document that outlines the technical terms of a proposed course of treatment or surgery and a laundry list of possible adverse consequences.
True informed consent is a candid exchange of information that includes a clear discussion of the patient’s:
It is imperative to provide the patient with realistic expectations of what might be achieved by the treatment, therapy, or procedure.
The informed consent process may require multiple discussions. Give the patient or the patient’s representative adequate opportunity to ask questions. The patient’s decisions must be made voluntarily without the appearance of coercion or pressure. The patient must have sufficient information to make reasonable and informed decisions regarding a treatment plan.
The basic principles governing informed consent and informed refusal apply equally for physicians practicing in academic teaching medical centers. However, given the nature of patient care in such institutions—where individuals in training participate to varying degrees—consider the additional factors that follow.
Under these circumstances, the attending physician can:
Attending physicians who do not inform patients, or who imply that they will perform the operation or render the care personally and then delegate substantial parts of the procedure or care to house staff, are putting themselves and the institutions they serve in significant jeopardy. In the event of an untoward outcome—even when a consent form has been used—such cases are difficult to defend.
Therefore, the key consideration is to make absolutely certain that documentation in the patient’s chart accurately reflects the disclosure made to the patient prior to treatment. In a teaching situation, the consent for treatment should always include the resident staff of the institution as well as the attending physician.
It should also be noted that various states have enacted legislation or adopted administrative regulations governing medical consent. Those state-specific rules have different requirements and should be consulted for a more detailed understanding of the law applicable to your practice.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.