A sound understanding of informed consent is an important characteristic of a well-educated radiology resident. Many radiologists are regularly involved in performing diagnostic tests such as biopsies and therapeutic procedures such as abscess drainages. For all of these procedures, the informed consent of patients or guardians must be obtained. When informed consent is handled well, it exemplifies key features of good medicine. However, when it is handled poorly, it can not only lead to poor decisions, but can actually damage the relationship between patient and physician and undermine patients’ general level of trust in the profession.
Consider a specific case. Mrs. Williams, a middle-aged woman, had been recently diagnosed with pancreatic cancer. One afternoon, the surgery team assembled in her hospital room to explain her situation, went over her options, and laid the groundwork for obtaining her informed consent, should she eventually opt for surgery. The conversation went something like this.
Mrs. Williams, we are sorry to bring you bad news, but the overall five-year survival rate for your disease is 7%. Once we get the CT scan results, there is a 20% chance that you will be a surgical candidate. If we perform the surgery, the chance that we can completely remove the tumor is 15 percent. Of patients who undergo successful surgery, the median survival is 12 months, and the number who survives to 5 years is 15 percent. If you choose surgery, the risk of bleeding is 7%, the risk of developing an internal hernia is 6%, the risk of problems with stomach emptying is 6%, and the risk of a leak from the pancreatic duct is 4%.
After providing more details about each of these benefits and risks, the team finally turned to Mrs. Williams: “What do you think you would like us to do?”
What is wrong with this scenario, and what insights can radiologists glean from it regarding what excellence in obtaining informed consent looks like? Before addressing this question, it is important to know where the idea of “informed consent” came from, and why it exists. Fifty years ago, most physicians would not have recognized the phrase, but today, is it positively ubiquitous throughout biomedical research and clinical medicine.
The term “informed consent” was first used in medical malpractice litigation in the 1950s. In some precedent-setting cases, patients undergoing medical interventions suffered certain forms of harm about which they successfully claimed their physician had never informed them. In one case, a man who underwent a prostatectomy was not informed that the procedure might leave him impotent. In another, a surgeon did not inform a patient that surgery on her breast might involve its removal. In still another, a court established that the patient, not the physician, should be the final decision maker. Today, performing a procedure without the patient’s consent—at least in non-emergent situations—may be deemed battery.
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
An elderly patient, Mr. Jackson, had suffered a serious car accident that left him brain damaged. The physician who was meeting with Mr. Jackson’s family to discuss treatment options did not enter talking. Instead he began with questions. “Tell me a story about him. What makes him laugh? Who does he root for on game day?” He then asked if the patient had ever said what he would want in such a situation. The family recalled him saying that he did not want to be dependent on a breathing machine. But the physician did not stop there. He asked what the family understood a Do Not Resuscitate order to mean. “A piece of paper that says they won’t try to save someone,” they replied. He then gently painted a picture of what a “code blue” would look like in a patient his age. At the end of the conversation, the family concluded that he would not want to depend long-term on a breathing machine—a difficult decision, but one they felt comfortable with.
Get Radiology Tree app to read full this article<