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Informed Consent Still a Flawed Process

There's a lot written about the informed consent process. Studies have compared oral conversations, conversation with diagrams or props, written materials and video presentations. The conclusion always seems to be that the more time you spend and the more effort you put into it, the better the consenting process. Unfortunately, studies have also shown that the moment you walk out the door the patient begins to forget everything you said, did, showed or demonstrated.  

Recently, I had to have some surgery, so I took this opportunity to study the informed consent process from the perspective of a middle-aged man who still possessed most of his marbles. That, of course, gives me a significant advantage over many of our cataract patients.

First came my surgeon, who took a chair at my bedside. "Paul, this is the informed consent discussion," he stated matter-of-factly. Good, that got me into the mood so I could pay attention. I wasn't medicated, so I listened to every word describing what he planned to do, how it might help, what could go wrong and how I might die if things went horribly wrong.

Next came the anesthesiologist who told me all about how she might chip my teeth, knock them out altogether and how I might die if things went horribly wrong.

Remember, I wasn't medicated, I was paying attention, and I'm in the business so I knew all the big words. Here's what I remembered the next day:

From my surgeon: "Paul, this is the informed consent discussion: blah, blah, blah, I'm going to blah, blah, you might die, blah, blah. Have you lost weight?"

From my anesthesiologist: "Blah, blah, blah, blah, nice teeth, blah, blah, nice smile, blah, blah, see you in the morning. Don't eat anything."

In One Ear, Out the Other?

If it took me only a day to start forgetting almost everything they said, how much of what I tell my patients do they actually understand or remember? I give copies of my informed consent information to all my patients. Some never look at it. Others study each word, mark it up with yellow highlighter and ask lots of questions.

Some patients want to learn everything about their procedure; some want to know nothing so they won't be scared, and some want the surgeon to shut up and get to work. Everyone is different. We don't need just one standard informed consent process; we need to be flexible so we can address each patient's needs.