Informed Consent: What Should I Discuss? Part 2

In part 1 of this post, I talked about the challenges that we encounter when having informed consent discussions with patients in the real world. In part 2, we're going to look at some practical tips for providing informed consent that I think you will find helpful.

Frame the discussion as a comparison of benefit and risk

We often become so absorbed in the risks of surgery and anesthesia that we forget why the patient needs surgery in the first place. Obviously, doctors recommend surgery to patients because they believe it will improve their health. I find it helpful, especially in patients who are at high perioperative risk, to reframe the discussion such that the patient is reminded that there are real benefits to be gained by undergoing surgery.  

Use a risk calculator

Nowadays, we have powerful tools at our disposable that allow us to predict the chance of complications. The ACS NSQIP Risk Calculator is great for this. It can be accessed easily from your smartphone. Document the possible complications and their associated percentages, and anyone who reads your pre-op will find incontrovertible evidence that you documented the patient's perioperative risks. 

Discuss patient-specific risks

If the patient has a specific clinical situation that imparts a higher risk of perioperative complications, this should probably be discussed with the patient. Examples include patients with pre-existing severe organ dysfunction, i.e. low EF, severe COPD, and higher than usual likelihood of blood transfusion. There's no law that mandates this clinical practice, but in many lawsuits where consent has been a point of litigation, the consensus seems to heavily favor discussing specific risks whenever they are higher than usual in a particular patient.  

Get others involved

Having the surgeon present for the risk discussion can be unexpectedly helpful. In most cases, the patient has met the surgeon before and has some degree of rapport with them. Believe or not, most surgeons are thoughtful about the risks of surgery and anesthesia, because a bad outcome looks bad on them, regardless of the cause. The surgeon adds valuable perspective regarding the benefits of undergoing the surgery. And, of course, the surgeon is a witness to the risk discussion. 

Keep it simple, don't overwhelm the patient

While talking with a patient, it's easy to go down a rabbit hole of percentages, what-ifs, and medical jargon. Just remember: when it comes to medical issues, most patients have little idea what you're talking about, and many are too intimidated to say they don't understand.

Of course, document

Be specific in your documentation. Include details. Like it or not, people will form an impression of your clinical care based on the quality of your documentation.