by Dr. Andrea Ignacio
Informed Consent – Treatment, Risks, Options and Alternatives
Occasionally conflict occurs during the intake of a new patient to InTouch, so we wanted to address the issue because it impacts every patient, as well as helping to highlight a major ethical issue common to all healthcare facilities.
Any time you register for treatment in a health facility (rehab, dental, medical, surgical and even in many spas) – in any facility that follows evidence based standards of care – each patient is given at least one Informed Consent form to read, discuss and sign. More likely, in larger facilities with multiple specialties, you will be asked to read and sign multiple informed consents prior to treatment. When we worked in hospital rehabilitation in Saudi most of the patients treated had signed a Hospital informed consent and at least one medical (procedure) informed consent per specialty, possibly a surgical informed consent at some point, and then a rehabilitation informed consent to treat in our department.
There are very good reasons for this and the basics of informed consent are quite simple. In health care, informed consent refers to the system or procedure in which the patient and the health care practitioner engage in a documented dialogue about:
- the medical treatment itself
- its risks
- its benefits
- patient options
- and treatment or lifestyle alternatives
Much of this dialogue occurs in the treatment room and is ongoing during every visit, but the most common side effects or other information are contained in the Informed Consent document, which must be signed by the patient and provider and witnessed by another person prior to the first treatment.
There are somewhat consistent but rare complications and conflicts which arise during the process of giving and accepting informed consent.
The most common negative reaction I experienced from patients in the US was fear after reading the risks of care. I myself have waffled at the doctor’s office between accepting care and signing, or running for my car and putting off treatment because one risk of some seemingly benign procedure is death…at the dermatologist? At the optometrist?! Believe me, we understand the fear reaction.
The most common negative reactions I’ve noticed from patients in Saudi Arabia or Bahrain have been that many have simply never been asked to sign such a form before. So on top of reading in black and white that a heat or ice pack can cause injury (minor burns or falls are the most common injuries, but still rare, that can happen during rehabilitation), patients are being asked to sign a form that at first glance seems to indicate acceptance of inevitable injury (or death).
The form is not intended or able to absolve the clinic or doctors of responsibility should a patient be injured through our mistake. This, unfortunately, is what most people fear and so they don’t truly hear or believe us when we explain that they are protected from that.
In most of these instances, fear-related tunnel vision causes failure to notice all the aspects of informed consent, especially those which benefit the patient. And sometimes, we as doctors or admin staff can become impatient and forget that the major purpose of informed consent is to open a dialogue for your education and understanding of your care.
The most baffling quirk of informed consent is that most patients in this scenario are willing to receive care, and trust us as doctors and therapists, but are not willing to sign an informed consent document – unwilling to sign that they understand the treatment, risks, options and alternatives for their condition and that they understand we will explain and answer their questions with regard to these topics throughout their time with us.
Consequently, it would be unethical to treat a patient who has declared themselves unwilling to understand their treatment, and irresponsible to treat any patient without clearly documented proof that we explained the treatment, explained that there are risks, options and alternatives of care, confirmed patient understanding, and attained clear documentation of patient participation in this dialogue.
Unfortunately those who refuse informed consent cannot be accepted as new patients.
We recommend that in addition to showing up for your new patient visits at least 15 minutes early, that you come prepared to read the entire Informed Consent form, and do not hesitate to ask questions if you have any.