Informed Consent Is a Farce

When was the last time you read every word of a 25-page quasi-legal document? That’s one of the questions posed in an opinion piece today in the New York Times by Mikkael Sekeres, MD, and Timothy Gilligan, MD, both of the Cleveland Clinic. They’re talking about the document patients must sign in order to be enrolled in a clinical trial.

But this kabuki dance of informed consent infiltrates all of health care, the authors argue. Sekeres and Gilligan say it goes something like this:

“Us: Blah blah blah.

You, as the patient, nod, and look like you’re paying close attention.

Us: Did you understand everything we said?

You: Yes.

Us: Any questions?

You: No.”

This “collusion” includes doctors looking harried and concerned (as they often are) when patients say they don’t understand what’s been told to them. So most patients don’t say that because the busy and important doctors need to visit other sick people pronto. Doctors know a lot about a lot of things. But they don’t know about everything, Sekeres and Gilligan point out.

“A fundamental challenge with this process is that it is often unrealistic to think that you actually could be fully informed of what you’re about to undergo,” they write. “How can we explain to you the experience of having your chest cracked open, or what it feels like when you go through chemotherapy? Neither of us has undergone heart surgery, or treatment for cancer, and we don’t kid ourselves that any depiction of the experience we provide will be enough.”

The authors offer some advice to patients how to really be informed enough to give true consent. They provide details of the following bullet points:

  • Ask to use common words and terms.
  • Summarize back what you heard.
  • Request written materials or even pictures of videos.
  • Ask for best-case, worst-case, and most likely scenarios.
  • Ask if you can talk to someone who has undergone the surgery.
  • Explore alternative treatment options.
  • Take notes.

Source: New York Times