Informed Consent: Are You Really Informed?

Informed Consent: Are You Really Informed?

 

08 Apr 2017

If I were a patient, what would I want to know about the risk of treatment? Since I’ve been one a few times, let me tell you what I worried about before past medical procedures. And will there ever be truly informed patients?

Let’s start with the major fear, death. Never forget that death lurks in the background, ready to strike. Surely, anyone who is scheduled for coronary bypass surgery realizes there’s a greater risk of dying in this case than when treated for an ingrown toenail.

But never underestimate the hazard of even minor surgery. There’s always the possibility, though rare, of death from anesthesia. It’s usually what we call an “Act of God”, in which neither the surgeon nor anesthetist is at fault. But regardless of the cause, you have still left this planet.

Moreover, even the best of doctors can have a bad or unlucky day. I recall watching a renowned Harvard surgeon who started an operation to remove a large uterine tumour. He was shocked to discover the patient was also pregnant! A horrible way to start the day.

Wealth and power are no guarantee against disaster. For instance, Sir Anthony Eden, the Prime Minister of England, had a serious complication during routine removal of his gallbladder. It eventually killed him. A surgeon may perform a thousand gallbladder operations, but then commit one technical error. So, even in the best of hands, there is no such thing as zero risk surgery.

But not only surgery can cause trouble. As a patient I’ve also been concerned about post-operative wound infection, one that is resistant to antibiotics, another “Act of God”. Or, that I might be given the wrong post-operative medication.

Years ago a patient of mine was dressing to go home after an uneventful major operation. Within minutes she collapsed, dead, due to a pulmonary embolism, a blood clot in her lungs. It was another “Act of God”, and no surgeon forgets those terrible heart-breaking moments over which he has no control.

So is “informed” consent ever possible? It could happen, I suppose, when a brain surgeon operates on another brain surgeon. They both know the risks. But I could talk all day with a nuclear physicist and be misinformed. Only if he told me that simply mixing A with B would cause an explosion, I’d understand.

So doctors must also learn to talk in terms that patients understand, as most patients are not doctors. In doing so they must be truthful but not scare the patient half-to-death about complications that rarely happen.

But surgeons and physicians should prevent patients from surprises. For instance, readers have complained to me that they would never have agreed to a radical prostatectomy for prostate cancer if they had been told they might end their lives in diapers.

Let’s not forget, however, that such medical procedures are often associated with great benefits. There are untold numbers of men whose lives have been saved by prostate surgery. Others are now able to walk without pain following knee and hip replacements. This good list goes on and on.

So what’s the bottom line? It’s that anyone, unless they’ve been living on Mars, must realize that life is risky, and more so if and when a medical procedure is necessary. The decision then must be whether the benefit is greater than the risk.

What’s most tragic is when unexpected complications occur and the procedure should not have been done in the first place. This may happen when surgeons too readily pick up the scalpel. But, today, my input from readers indicates they’re often their own worst enemies, those who demand instant pain relief from surgery rather than live with minor inconvenience. The end result is often not the perfect outcome they had hoped for.

Sometimes it’s better to live with the devil you know than the one you don’t know.