2017 HSC Section 2 - Practice Management

Informed Consent and the Surgeon

J Am Coll Surg

Childers et al

Figure 1. The major ethical requirements of informing the patient during the informed consent process. Note that the boxes represent separate components of the process, but they overlap to signify their interrelationship.

of information that patients do not perceive to be impor- tant. 7,8 Clearly, both the mechanism and content of the informed consent process can be suboptimal. This fact is reflected in empiric data that show both physician and patient dissatisfaction with how well the elements of in- formed consent are fulfilled. 5,6 Informed consent is particularly important in the surgi- cal realm. Given the procedure-based nature of surgery, informed consent must be an integral part of every sur- geon’s daily practice. In addition, surgical patients often need the most information and guidance because many surgical procedures are complicated and the attendant risks and benefits are unknown to patients. Patients frequently approach surgery with a wide range of emotions, from “profound distrust to unquestioned faith,” 7 further com- plicating the process. Insights like these solidify the impor- tance of the informed consent process and the need for practicing physicians to reevaluate their own understand- ing of the components essential in this process, not to men- tion the need to improve resident and medical student training. Although an understanding of informed consent can be achieved through either legal or ethical channels, it is our opinion that a purely legalistic viewpoint is too reduction- istic to be of great value. Our intent is not to provide a comprehensive review of the literature on informed con- sent. Such an exhaustive philosophical and historical re- view may not be pragmatic for the practicing surgeon. Rather, we here seek to provide a perspective that focuses

both on the ethical and pragmatic applications of informed consent that may be more valuable to the surgeon. In doing this, our hope is to encourage surgeons to think about informed consent not as a mandatory part of their daily clinical practice, butmore importantly, as a fundamental com- ponent of cultivating the patient-physician relationship.

Informed consent: ethical and practical considerations

Informed consent is often conflated into both a single the- oretical concept and a single practical endeavor. Although we often discuss informed consent as a single entity, it is helpful to deconstruct informed consent into two distinct components: “informed” and “consent.” Although each of these elements is necessary, neither alone is sufficient. In addition, the skill set and ethical considerations involved with each element are somewhat distinct. As such, for il- lustrative purposes, we will address the elements of “in- formed” and “consent” in their own right. Informing the patient Although the process and scope of “informing” the patient has been widely debated, 2,8-10 for pragmatic purposes we will present three general steps: physician disclosure, pa- tient understanding, and patient decision-making ( Fig. 1 ). Physician disclosure entails conveying relevant and ger- mane information to the patient. The scope and nature of this information is determined, in part, by an understand- ing of the values and interests most significant to the pa-

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