“Un”-Informed Consent

In today’s The Boston Globe, the article “Know risks before saying OK to surgery” discusses the importance of the informed consent process. It tells a story of a woman who was asked to sign the informed consent forms after she had already been prepped for her surgery, having received anesthesia and without her reading glasses. She described that there was not enough time and (obviously) poor circumstances for her to understand what she was signing and there wasn’t anyone to ask.

The article suggests a few reasons why the informed consent process is flawed so often. One study addressed the fact that “many forms are written for people who can read at the 11th or 12th grade level or higher, despite the fact that many adults read at the 8th grade level or below.” But in another study, the “only thing that really worked was face-time with a doctor or nurse.”

There are a number of “just in time” clinical reference information tools available at or near the point of care such as UpToDate, which is endorsed by many specialty societies and may have over 50% physician penetration in some specialties, as well as MD Consult and Harrison’s Online. There has been strong demand from specialists and academic physicians, much more so than community-based primary care physicians. We believe that the shift toward evidence-based medicine and push towards better clinical quality information on both doctors and hospitals will imply an increase in demand over time. These tools provide excellent, detailed clinical content with clear patient education materials to be used during the informed consent process.

These point of care tools are beginning to be recognized as enablers of painless, fast payback quality improvement initiatives. As many doctors and hospitals now view the informed consent process as one important factor in managing malpractice, these tools are seen as having immediate payback. However, these tools cannot be used alone, but as a complement to the “face-time” with the doctor to answer all the patient questions. I would agree with The Boston Globe journalist who concludes: “Remember: Informed consent is supposed to be for you [the patient], not the doctor or hospital.”

July 25, 2005

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