Wednesday, January 16, 2013

Informed consent FAIL

Another thing I hate about consent forms:

Back in residency, I was scheduled to do a biceps tendon injection on an elderly female patient and naturally, the first thing she said when I walked into the room was, "I've been waiting an hour."

"I'm sorry," I said. What could I say to that? Patients get so angry that they're waiting, but it's not like the resident has any control over it. Did she think I wanted to double book patients? Note to patients: we're not sitting around sipping tea while you're waiting. (And then those same patients are probably the ones who call the clinic and BEG us to overbook them for an earlier appointment.)

Anyway, I set her up for an injection and handed her the consent to sign. For every outpatient procedure in the entire hospital, we used the same standard consent form and I just wrote the procedure on one line at the top. As the patient was carefully looking over the consent prior to signing it, I let her know, "That's just the standard consent that's used for everything in the hospital."

She signed the consent and I got the supplies ready and came back to the room.

"By the way," she said to me, "I don't mean to be rude, but just so you know, you should never EVER say to a patient that it's a standard consent form."

"What?" I said, baffled.

"You should let the patient read the consent," she said, "and if they ask, then you can tell them it's the standard consent. But never tell them that." She said all this to me with this huge shit-eating grin on her face, which made the bitchiness of what she was saying very unsettling.

"Um, I let you read the consent," I said.

"I'm just telling you this so that you can learn something," she said.

What I replied was: "Okay."

What I really wanted to say was: "I have a tip for you too. It's not such a good idea to be a patronizing bitch to the doctor right before they stick a bigass needle in your arm."

God forbid she should feel that I'm rushing her at all after she already astutely noted that we were running an hour behind schedule.


  1. I bring my Kindle to appointments, the ED - ANY PLACE I could receive care and where a patient with far more complicated symptoms could get in front of me. Common sense - smart patient perspective. :-)

    1. I don't mind waiting for appointments in themselves. I guess when I get upset, at least, is when I have to be somewhere at a certain point in the future. Like if I have to pick my kids up by 6, and I go to an appointment at 4, thinking I'll have plenty of time, then suddenly it's after 5. Right now, I'm on a very tight schedule :)

      What my ob/gyn practice did once that really pissed me off was that they called me specifically saying they were running ahead of schedule so could I come in early so they could finish early? I said sure. And I did, and then waited there for 45 minutes. (Speaking of things you should NOT do to your patients.)

  2. You should have told her you'll be right back, gone and saw a couple patients, and then come back. I bet she wouldn't have that grin on her face anymore.

    1. It's hard to do that when you're only the resident...

  3. OK, she was rude and had no respect for the big-assed needle and the small-assed but tough person weilding it.

    However, (and I hate to be the one to tell you this, Fizzy), but she was right, in context, if not in delivery. MOST standard consent forms are pretty indefensible on their own, should a case go to court. I am not saying that the consent form you were using wouldn't stand up to legal scrutiny ... a lot depends on the detail and the specificity ... but it is always prudent to orally explain to the patient exactly what you are going to do, give a little run down of the usual things that might happen, ask her if she has any questions, and then give her the form to read and sign. Of course, then you document what you talked to her about, as well as the procedure itself.

    I am not saying that the patient would prevail in a suit based on inadequate informed consent, but just getting sued is a bitch. Before thyroid surgery once, I had the doc explain to me in great detail each nerve she would encounter, what would happen if one was damaged, the national average for that complication, and her personal percentage of having each complication occur. I thought to myself that this was really over the top for the average patient, but it occurred to me that she might have been sued at some time for inadequate informed consent. Did you happen to notice if she was a lawyer, a legal nurse consultant, a risk manager, or any combination of the above, which is why she had that horrid smile?

    I consider the most important part of my job to be protecting good docs whenever I can, so I guess I just couldn't help passing on this little piece of advice to my favorite physician blogger. But now, I feel as bitchy as the patient, so I'll just shut up before I'm banned from reading your blog. Tricia

    1. Well, I did tell her everything we were doing prior but it wasn't about that. I just wanted to let her know all the details of the actual procedure were in my handwriting and all the small print that she was taking her time reading had absolutely nothing to do with the procedure she was about to have, and just the standard hospital form that every single person signed no matter what procedure they are having. So, in my opinion, it was a waste to read if she was trying to learn more about her procedure.

    2. Aha. Sorry, I didn't get that. I will henceforth try to keep my legal hat away from my pleasure-reading hat. Tricia