The “Less Is More” Medical Campaign – Part 3

The latest campaign of "less is more" leaves a lot to be desired.  Doctors love to leave patients is the dark and ill prepared for medical procedures.  They claim that there is a fair amount of uncertainty about the potential benefits and risks of the vast majority of medical procedures.  In an ideal world, patients would learn about all the risks and benefits of a treatment and its alternatives, including doing nothing, through the process of informed consent and shared decision-making.

But, unfortunately, we have a fundamental problem with informed consent as it is practiced today.  What could be a platform to promote the idea of "nothing about me without me" has devolved into a perfunctory exercise by medical personnel to ensure that the "chart" has the proper paperwork.  Meanwhile, consent forms are often completed with patients being minutes away from a procedure, commonly supine, and even sometimes sedated.

This is not informed consent and smacks of decision by decree, often initiated by the doctor.  I have been fortunate with some of my doctors that actually took time to explain what would happen, what was expected to happen, and the worse case of what could happen.  Then I was questioned about what I wanted accomplished and if I agreed.  This was what happened before my gall bladder surgery and even though I knew my gall bladder removal was necessary, time was allowed in a meeting before the surgery to ask questions and have the procedure explained several days before the actual surgery.  I was given a sheet of instructions on eating and fasting to prevent potential problems and my diabetes regimen with changes was discussed. 

When the actual day of the surgery arrived, a brief discussion took place and I was allowed questions if I had any.  This was very reassuring and put me at ease for the surgery or anesthesia.  When I became aware after the surgery, a nurse was there to explain how the surgery had gone and that I would be allowed some broth after a few hours.  I was allowed water almost immediately and my CPAP was set up and made ready if I wanted to sleep. 

It is true that the consent form was a standardized form and it was readable by me even with a paragraph of medical jargon.  It is a shame that consent forms are not written for patients to understand and even more shameful that the consent process is not respected by surgeons and their staff. 

This is true because the medical culture has not promoted shared decision and the time allowed by the system is against this.  Then most patients do not easily understand the tools needed.  It is physicians' responsibility for elective procedures to be sure that patients understand their options and recognize their power to make choices.  The physicians need help to make this meaningful for the patients.

Patients need to know that there is a choice and they have permission to make a choice.  Patients should be made aware that the choice is not set in stone.  The patient's preferences are as important as the facts about risks and benefits.  Patients deserve personalized estimates of what the potential risks and benefits of various strategies may be.  They deserve information about the medical team's experience with different strategies and outcomes.  Patients deserve to know what a procedure will cost them out of pocket if everything goes well.  All of this information is vital and ought to be part of informed consent.  In fact, the obligation is that doctors need to ensure that patients know that two people presented with the same information may make different choices and still be right.

Finally, the informed consent should be taken out of the time just before the procedure and have time allowed for questions and answers.  Doctors should be prepared to teach their patients and know that the system supports the patients.

To be continued next week.

Make Sure You Are Aware of All The Risks

I am concerned that many patients are needing to tell their doctor after a medical procedure - “I'm sure you didn't tell me about those risks!” There are a lot of reasons for this, some problems belong to the patients and a good number belong to the physicians or the inadequate papers supplied to the patients. Read this article for a better understanding.

Since I am a patient, I will tackle the errors made by patients. One of the biggest errors made by patients is putting complete trust in the doctor and not reading the papers that are supplied beforehand by the doctor's team. Yes, they are given to you to read and that is what you are to do. After reading these papers, make a list of questions either not covered by the papers or that you have concerns about. These should all be answered to your satisfaction before you allow any operation or procedure to proceed.

As a patient, it is your responsibility to read and understand the procedure as delays on the day of the operation can be costly for you – rescheduling often is not covered by your insurance. And the hospital has unused time and wasted space as a result of your delay. That is why it is best to get questions resolve before the day of the procedure. That is another reason to get all the paperwork done before anything is to be done and beware of a doctor that waits until the day of the procedure.

If needed delay to procedure to have all the questions answered. The doctors and people involved in the procedure may not be happy, but most will understand and know that you are being as thorough as you should be and as they want you to be. Normally, there is time before any procedure to fit this in. If the doctor says I covered this and tries to get your signature without answering questions, refuse to sign and take this up with the insurance carrier and hospital administration or appropriate state agency to put the doctor on notice for improper behavior.

Physicians from my experience generally do an excellent job of explaining planned procedures to patients. The problems are that patients often tune the physicians out and the documentation of these conversations is often severely lacking and that unfortunately is putting it mildly. Even in a survey of 402 physicians, 87 percent reported that most or some of their patients were under- or misinformed.

Today with new technology, this problem should become less and less and doctors and healthcare organizations become aware the informed consent software exists.
Much of this software is very detailed and the packets patients receive is easy to understand and not written in legalese or medical jargon to confuse the patient.

Typically those packets include a copy of the procedure-specific consent form, which is comprehensive and easy to understand. Patients are always offered a copy of their consent form, which then serves as a transcript to help them remember the informed consent conversation and their choices.

Larger practices and hospitals that have invested heavily in automation have even more flexibility in documenting informed consent using software.

Software is a great improvement and helps reduce liability risk for physicians because the software is often procedure specific and the packets given to the patients have everything spelled out for them. If the patient tries to tune out the physician or just does not read the packet, problems remain with the patient and do not transfer to the physician.

The software also improves patient flow (at least for those that have read the packets) and time is not lost with questions covered in the packets. The packets will cover pre-procedure instructions and requirements of food and fasting. Then the packets will cover post procedure instructions and patient requirements. Lastly, the software generally improves patient understanding and satisfaction.