A thought on informed consent

06.09.2018

Informed consent is often believed to be a discrete event such as obtaining a required signature on a form for a specific procedure. However, Informed consent is so critical to the practice of medicine and protecting patients' right to participate in decisions about their care.

For valid informed consent to occur, the physician is obligated to disclose all the relevant information about a proposed treatment or procedure to the patient, and the patient has to understand that information and be able to make a voluntary choice.

How can physicians help patients in a practical way become truly informed in decisions about care?

The physician should make his/her thinking sufficiently transparent enough that patients understand how a recommendation was made (i.e., by identifying the problem and the advantages and disadvantages of the medically reasonable options).

Here just my example: your symptoms are related to prostate enlargement. According to the severity of the symptoms and the risk factor for the progression of the disease you should be treated. The treatment goal is the relief of the symptoms that are affecting your quality of life. We have 2 options: 1) medical treatment (with risk and benefits); 2) surgical treatment (with risks and benefits). Since we didn't start any treatment yet and you have the chance to improve with the medical treatment only, my recommendation is to start it and to check the results in a period of time. After that, we can decide if we have to move further by choosing other surgical options. What do you think about what I've said?"

If the patient nods in agreement, the disclosure obligation has likely been met. To ensure patient understanding, the physician goes on, what questions did you have? To make sure I haven't made this too complicated, can you tell me in your own words why I made this recommendation? I don't want this to feel like a test. Gauging your understanding helps me know if I need to clarify anything I've told you.

If you timed yourself saying that, you saw that it took about 60 seconds. In established patients or for patients with routine medication changes, these conversations are likely to be even shorter. In conversations about more complicated decisions, it might be longer, but the basic structure remains.

When physicians make patients' care understandable to them, they do their basic obligation to respect patients' autonomy, promote their participation in decisions about their care, and ultimately help them make the right decisions for themselves. If informed consent is important to the ethical practice of medicine, it is for this reason. Ideally, by making a physician's thought process transparent to the patient, it helps the physician to make their language understandable and ideally better inform patients about their care.