[The Daily] – Expecting the layman to be a doctor
Expecting the layman to be a doctor
2006-05-24
You’re in the doctor’s office, and she’s just handed you a form to read. While you’re scanning over the form, she starts to explain it to you. It’s your consent-for-surgery form and it’s telling you what the surgical procedure is, what the goal of surgery is, and what the risks are — from common side effects to rare complications.
This sounds simple and is common sense. It is, in fact, a required step all hospitals must go through in order to maintain accreditation. So what’s the problem with informed consent?
Often, the problem is in what your doctor does. For example, do you understand the following?
“A neurolytic sympathetic blockade of the right stellate ganglion nerve bundle with bupivacaine and a corticosteroid.
“Potential complications include injection into the vertebral artery, phrenic and superior laryngeal nerve block and rarely, intrathecal injection.”
Chances are good that, unless you have a strong medical background or have been subjected to a similar procedure to the above, you have little idea of what that meant.
Yet, it tells you the procedure, the risks and potential for complications. It gives information necessary to make an informed decision. Or does it?
After all, if you can’t understand what is being said, you can’t really make an informed decision.
The problem is, many see doctors as people in a position of authority. Doctors have knowledge, based on their education. Because of this, patients trust what doctors say needs to be done; this is often blind faith.
Or, at least uninformed faith.
According to Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, “The informed consent process has become more of a shield than a doorway,” which protects the doctor and hospital from malpractice instead of empowering the patient to understand his or her treatment.
There are two major problems interfering with the notion of true informed consent: reading comprehension and education/medical knowledge.
The first is very simple: Informed-consent forms, those that you read and often sign before anything from a vaccine to a surgical procedure, are, according to the e-journal of the Association of Medical Directors of Information Systems (TIR), written in college-level language.
The average American adult reads and comprehends at approximately an eighth-grade level.
Writing for an eighth-grade comprehension level does not have to mean dumbing things down.
TIR gives an example of how this can be achieved. Instead of saying: “Adhering to treatment recommendations is often fraught with difficulties, for families have a multitude of scheduling commitments, and may also be highly insecure about their abilities,” doctors and their consent forms can say, “Families often find it hard to follow treatment recommendations. They are short of time. They may also doubt their skills.”
The same information is conveyed, but the second phrasing is much more accessible.
Accessibility leads directly to the second major issue with informed consent: Your average layman is not a doctor, and should not be expected to understand medical treatments, procedures and options.
Many physicians take the notion of informed consent to mean they should provide the patient with all treatment options and potential risks, then allow the patient to make the decision on his or her own.
So long as the physician is explains each treatment option in comprehensive terms and there is no coercion, there should be no problem with the provider giving opinions on the treatment.
In fact, this should be the encouraged norm.
Informed consent stems from a noble idea: That the patient, not the physician, should be making the decisions important to the his or her life.
Unfortunately, the information overload ends up bringing us right back to the position we were originally trying to get away from: The paternalistic doctor making decisions for the welfare and well-being of the patient.