Effective Informed Consent: Fostering a Dialogue

Hippocrates once promoted the beneficence model of medicine, which encouraged minimal communication with patients about their condition. Like Hippocrates, those days are long gone, and guidance now supports the idea that patients need to understand planned medical procedures adequately so they can make informed decisions about their treatment. Effective informed consent requires a dialogue with the patient wherein he or she feels comfortable fully participating by asking clarifying questions and offering personal concerns.

Requirements for informed consent have not changed in modern healthcare, but the delivery has seen strong consumer momentum to encourage a better exchange of information. Traditionally, informed consent was limited to operative procedures, but, in recognition of the high-tech nature of medicine and the potent medications that have been developed, it must now encompass a broader range of medical care, including:

• surgical procedures
• significant medical treatments
• prescriptions with severe side-effects

Physicians are bound, in advance of this medical care, to provide the patient with detailed information on the risks, benefits, and alternatives, including the option to not perform the procedure or treatment regimen and the effect that doing nothing would have on that patient’s health status. They are also required to inform the patient about any potential clinically significant adverse drug reactions or other concerns when a new medication is ordered.

Patients can be overwhelmed by medical jargon and may be medically naïve, so it is imperative for the physician to foster an open dialogue with the patient and allow adequate time for discussion, translating key terms to common language and providing commonly asked questions that may put the patient at ease and stimulate further questions. It is important to base information not only on personal experience, but on broader sources as well. Verify understanding by asking patients to restate or recall key elements so the patient has an accurate understanding and does not develop unrealistic expectations, which often result in unfair complaints about the practitioner’s care.

An area often minimized prior to medical care is the recovery period. Prior to treatment, the physician should discuss any limitations or unwelcome surprises that may arise. Often the focus is on early medical issues (e.g., pain, possible infection, drainage), but it is valuable for the patient to also understand what life will be like for a longer period of time. Perhaps they will require readily accessible restrooms or will not be able to perform household activities. Finally, physicians will strengthen understanding and reduce potential complaints by including family members or friends in the discussions.