I do a fair amount of procedures (mostly injections), and one thing I must do prior to every injection is obtain informed consent.
Getting informed consent often takes longer than the procedure, in all honesty. (I mean, how long does it take to stick a needle in a shoulder?) First, you have to tell the patient about the procedure, including the risks and benefits (I always accidentally write "injection" as a risk, meaning "infection"), then you show them the consent form. And they have to sign it, which in the case of my patients, can actually be a bit of a process. And then I have to track down someone to witness the consent.
And THEN there are about five or six other places I have to sign and date the form, like to say that I verified I have the right patient, that I'm injecting the correct side, etc.
Recently, I was near a colleague of mine who was finishing filling out the consent form and he started grumbling, "This form is ridiculous. You have to sign it like ten times."
He was right. But here's the thing: for every place you have to "sign and verify", it's because somebody else did something stupid. We have to sign that we checked that we're injecting the correct side, because obviously a bunch of people injected the wrong side.*
So in that sense, I do think it's important.
But in another sense, if you're signing and dating the form five minutes after the procedure, I'm not sure how much it's going to help those errors. And I bet that's what 90% of doctors do.
*A favorite quote of mine:
"If you have the fever, there's only one cure; take two tickets and see the game Sunday morning. Warning: tickets should not be taken internally."
"See? Because of me, now they have a warning."
Good Simpsons quote Fizzy!!ReplyDelete
I like to spot the subtle Simpsons references in Fizzy's posts. I made a game out of it (that was a Simpsons reference too...anyone remember that one?)Delete
Nobody can lick more envelopes than me in an hour.Delete
oh, you're good Fizzy.Delete
I have two providers who each do several injections a year -- one has me sign an annual consent, which they keep on file. No need to do another one unless type of injection changes (he is a physiatrist). The other is an orthopedic surgeon -- other than long ago, I have not signed a consent form for a joint injection in this (or any other) ortho office. They verbally go over risks and benefits, answer questions, do injection. No muss, no fuss. Let's keep everyone safe, but reactionary creation of more paperwork is driving people out of medicine, lowering productivity, taking time away from patients, etc.ReplyDelete
I agree but it only takes one "they never told me that" and the practice is gone. Many docs practice defensive medicine. It is what it is.Delete
According to a risk management course I just took, a patient could win a lawsuit based on "they never told me that" even with a consent form that says "that".Delete
yeah -- that's kind of what i always thought as well. If there's a bad outcome, or the patient is unhappy in some way and is also litigious (it is the U.S. after all), they'd probably just sue anyway even if you have a 10-page consent form, and even if it was a known complication. And whether or not they win really has little to do with medical facts.Delete
p.s. on that show "the good wife" last week, they had a case where a family was suing a bank that foreclosed some houses for their kid getting West Nile -- try and line up that chain of causality! (yes, i know it's fictional - but somehow doesn't sound too far from reality)
At the hospital where I did residency (I'm staying anon for this one!), our consent for ANY procedure consisted of telling the patient about said procedure, then writing in the chart "PROCEDURE X: R,B,A,P discussed w/ pt & pt consented." And yes, R,B,A,P stood for "risks, benefits, alternatives, & personal," & the was approved/recommended by the BIG BAD BEASTY LEGAL Team b/c they could fight anything, since NO consent form could ever contain EVERY possible potential scenario.ReplyDelete
While I'm sure once can imagine how this whole situation mimight be misconstrued, now that I have to consent w/ stupid state mandated lengthy paper forms that have impractical potential complications that aren't even relevant a large percentage of the time, I really miss that old system.
I've heard this too at the local, nationally-renowned Children's Hospital - don't put specifics in the documentation; state only generally that everything was discussed specifically.ReplyDelete