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Informed Consent: Does that Include Personal Detailing of Your Doctor?
There is still debate in the medical, ethical and legislative
community as to how much information is enough as part of informed consent for
the patient or the patient's surrogate to make a decision as to whether to have
an operation or other procedure or medical treatment. And is there such a thing as "too much
information" for the patient to be told and expected to understand? That
is still debatable. There is no debate as to the legal necessity for a
patient's autonomous decision regarding their treatment but the question is
"how much?" but also "what kind?" For this thread I want to focus on a specific
category of "what kind?" and that is: should the patient be permitted
to ask personal questions about the doctor and followed by detailing by the
doctor to the patient regarding the doctor as a person and as a
Lance K. Stell PhD, teacher-ethicist, has specified my focus
with the following:
Informed Consent disclosure duties of the physician were “procedure focused” NOT provider focused.
states (e.g. Pennsylvania and North Carolina) have aggressively restricted statutory Informed Consent disclosures
to the recommended procedure, and its alternatives, including the option of no procedure,
along with a discussion of the risk/benefits of each option.
states have expanded the physician’s disclosure duty to
the extent of his/her training and experience with the particular
(and the hospital's) when the outcome disparities between providers
the proposed treatment were “material"
development and entry of Big Data bids to expand disclosure duties (and
on physicians to discuss) considerably. For a few examples:
many of these procedures have you done, doctor? How many recently? What is
Morbidity and Mortality Rate and your (and your hospital’s) 30-day unplanned
readmission rate? Have you ever had a “never event?” You are
proposing to do my operation laparoscopically, but suppose you find it necessary
to “convert” to an open operation. Do your privileges include doing the
procedure open, or must you call in a colleague who has such privileges for back up?
What might be his/her responsibility or role in the setting of such “conversions?”
New rules give me a right to tell you my preferred manner of
communication. So please, I prefer all information you give me about risk
in statistical terms, not qualitative terms.
Tell me about your Conflicts of
Interest. “I noticed that
you're on the Federal Government’s list for having received payments from
the medical products industry. Does that imply that you’re taking kick-backs or
are under suspicion or something?”
Tell me about the instrumentation you propose to use for
my surgery. How big a profit does you hospital get on it? I support
cost-effective care. Has any of it been implicated
Device Problem reports to FDA? If so, have you considered using other
instrumentation? Why not? And how are you compensated for your work?
I strongly disapprove of "fee for service".
this is just the tip of…”By the way, when's the last time you got a good
when you go to the hospital for an appendectomy, about to start chemotherapy
for a diagnosed cancer, are suggested "new" medication rather than
the established drug for your illness, is there more you need to know beyond
the lab tests, your doctors interpretation of your history, physical and labs?
Do you also need to know also more about the personal details about your
doctor? And, if so, should you wait
until you are immediately challenged to make an informed consent or should all
this be part of the first selection of a doctor for your care? ..Maurice.
Graphic: Images from Google Images and modified by me using ArtRage.