Wednesday, February 27, 2008

Patient Rights

Informed consent. It's a long history, but informed consent came about when patients started asking for more autonomy in their patient care and the term "patient rights" came into being. I'm all for patient rights and autonomy and it's definitely the right direction for patients to go towards. Of course, there has to be a limit to what a doctor can or has to do, and this article does an excellent summary of listing and explaining common myths about informed consent:

http://archinte.ama-assn.org/cgi/content/abstract/156/22/2521

Let me summarize.

Myth 1: A signed consent form is informed consent. Just because somebody signs a piece of paper saying they understand all the risks and potential complications of a procedure doesn't mean that they understood everything you tried to tell them, or everything that's on that piece of paper. Some of those consent forms are pages and pages long and full of jargon, so that could actually confuse someone more than it helps.

Myth 2: Informed consent is a medical miranda warning. There's more to informed consent then tell patients all the risks of a particular procedure or action. You also need to tell patients about options, potential outcomes, etc.

Myth 3: Informed consent requires that physicians operate a medical cafeteria. For a given problem, there might be 20 different ways of going about treating it or solving it. A doctor doesn't actually need to present all 20 ways - in fact, this usually confuses the patient! The doctor only needs to (and should) present a couple of the methods (usually what the doctor thinks is best) to the patient and information about the different methods. And physicians can still give advice - the goal is just to not be paternalistic. In fact, patients often ask for advice ("what would you do if you were me") in addition to the information and welcome it. Doctors don't have to just sit back and let the patient choose out of all the options with only factual information.

Myth 4: Patients must be told everything about the treatment. This is certainly not legally required, and if doctors did this, it could take hours. Ethically and legally, a doctor should tell a patient everything a "normal" patient would want to know, and then of course, ask if the patient has any questions. A doctor cannot and should not be sued or deemed a bad doctor because he failed to disclose an aspect of the treatment that is very rare or that the common patient wouldn't care to know at the beginning.

Myth 5: Patients need full disclosure about treatment only if they consent. Theoretically, patients need to know about important things before they consent if they are trying to choose between options.

Myth 6: Patients cannot give informed consent because they cannot understand complex medical information. While a patient might not be able to remember or recall everything that was explained in the office, during that office visit, they will probably understand everything well enough to make a decision. Secondly, things need to be simplified in a way that patients can understand things. If a patient is incapacitated or incompetent in a way that makes them unable to make decisions for themselves, then there needs to be a surrogate decision maker.

Myth 7: Patients must be given information whether they want it or not. It is certainly within a patient's right to not participate in decisions affecting their health care - they may leave it up to a family member, or even their doctor. The doctor shouldn't force a patient to listen to them if the patient truly wants to give up this right.

Myth 8: Information may be withheld if it will cause the patient to refuse treatment. In no instance is it right to withhold health information from the patient about him or herself.

I think this article is great, because often doctors feel they have to tell the patient too much, or there are doctors not telling patients enough. Conversely, there are patients who expect things that doctors aren't obligated to give. Of course if they ask, it is usually given, but just because a doctor doesn't give it, doesn't mean they're a bad doctor. The article basically explains to both doctors and patients what is expected of them during an office visit, and that's been a relatively murky issue for quite a while - at least in my mind.

2 comments:

Steve said...

Most states have informed consent laws but they are often vague or ignored. This is a good start but does it go far enough. Simply telling a parent that they want to put the child on an antidepressant or other psychotropic drug is not enough. Are they required to explain that there are no medical tests that can determine if their child has a seratonin or other chemical deficiency? Are they required to state that seratonin given to some groups of lab mice provoked violent behavior? Are they required to explain that one recent study showed that a placebo was as effective as an antidepressant? Are they required to tell the parent that 52% of the suicides by women in Sweden in 2006 had filled a prescription for antidepressants within 180 days of their suicide?
If they are not required to present this information, is it really full disclosure?

As the director of Novus Medeical Detox, I can tell you that none of our patients were given sufficient information about the side effects or the ability of medicine to determine their need for seratonin.

Steve Hayes
http://novusdetox.com

JoJoJangJang said...

I think it's a good question... I certainly don't know the specifics about serotonin therapy itself so I can't comment on that. I do believe that if a side effect is common (or even just not rare), it should probably be mentioned, especially if it is a serious side effect. Of course, the definitions of common or rarity aren't exactly defined, so it's definitely a judgment call. I'm not sure what to make of your comment about the antidepressant prescription either... I'd have to see the study, but I'd be more convinced if you said that compared to a control group, there were higher rates of suicide in depressed women that received an antidepressent prescription than in depressed women who did not receive an antidepressant prescription.