Sunday, December 11, 2016

Hospital Consent Forms and Other Stories

Even though I am over 40 – by a long shot – I am familiar with the abbreviation TMI.  We are inundated with so much noise, chatter and static.  I feel that we are bombarded with information that we must sift through and ultimately delete.  The news cycle is 24 hours and hits us from so many electronic sources simultaneously.  I am deluged each day with so many unwanted and unsolicited e-mails from organizations that I have never heard of.  One of my favorite words on their e-mails can be found when I scroll to the end.  UNSUBSCRIBE!

Another genre of information assault is the panoply of warnings and disclaimers that we confront.  Of course, we are all numb to them since we have been so supersaturated.  I’ll prove it to you.  The next time you are about to take off on an airplane, the flight attendant will review safety information in the event that a catastrophe occurs.  While one might think that folks would be attentive to information that might be useful if the plane loses altitude or is headed for a ‘water landing’; no one is paying any attention at all.  Most of us are browsing through the Skymall catalogue which showcases amazing gadgets, such as a device that can dispense feedings to your cat during a week of your absence.  For the cat’s sake, I hope there won’t be a power failure.  Moreover, the flight attendants who are issuing the briefings seem more bored than the passengers. 

How often do we hear the nonsensical phrase, this product is not intended to diagnose, treat, cure or prevent any disease?  In other words, we admit our product does nothing, but please buy it to for your ailing bones and prostate glands.

How often do we hit the I Agree icon, which follows pages of lawyerly small print, just to get to the next page? 

We have been over-warned, over-disclosed and over-disclaimed. 

While rounding at the hospital, I saw the following sign posted on a coffee machine.

Newsflash!  Hot Coffee is Hot!

Look what fear of litigation has done for us.  Prior to ligitomania, we might not have realized that hot coffee is actually hot and might injure of us if we spilled its steaming contents onto us.  Now, we are all much safer knowing that hot beverages, which we desire to be hot, are hot.

Of course, these protections extend beyond steaming beverages.  If I were in charge, I’d issue rules and regs that would mandate the following warnings.
  • Caution: these steak knives are sharp and not intended to remove feet callouses
  • This chain saw is for industrial use by trained lumberjacks.  It is not intended as a toy for children under the age of 7.
  • This lighter fluid is dangerous and should not be stored in a child’s crib.
The medical profession is a part of this game also.  Every day, I have informed consent discussions with patients regarding procedures that I have advised them to undergo.  These are informal conversations when I try to give patients sufficient information so that they can make informed decisions.  This is reasonable and a fundamental part of the doctor-patient relationship.

The hospital, however, is not satisfied with my efforts and requires that patients sign lengthy consent forms, which most patients sign blindly without reading them.  For any readers here who have had the pleasure of having enjoyed hospital life, I’m sure that you can attest how many different forms you have signed from the moment you arrived at the hospital door to your discharge.  Most patients and physicians regard these signings to be mere formalities, which are intended to protect hospitals, and not patients.  If patients actually took the time to read through all of these legal CYA forms, it might grind the hospital to halt.  There's not enough time for patients to read and understand all this drivel.

Caution readers!  This blog is not intended to inform, enlighten, provoke, challenge or amuse readers.  Readers accept all responsibility for any resultant angst or mental torment and hold blogger harmless for any and all perceived damages until the end of time.  Click I AGREE.


  1. There is also confusion regarding what constitutes actual consent. Specifically, we confound the signing of the informed consent document with the acts of informing and consenting. In my particular state which has very loose requirements for obtaining written consent, much of what we do can be done under verbal informed consent. However, there is a tendency to assume that if no written consent is required, no consent is required whatsoever. On the flip side, there is also a perception that if something is signed, then informed consent has been accomplished, even if no informing has been undertaken, whatsoever.

    The written documents often get in the way of any real informed consent because they are created by those who have no idea of what the actual risks and benefits are of any specific intervention. We are forced to get written informed consent for trivial interventions using boilerplate documents which include risks such as death or paralysis where the riskiest part of the intervention is getting patients on the exam table. The documents bear little or resemblance to actual informed consent tools and are in reality signed releases.

  2. @MC, I completely agree with your comments. The signing of consent documents has become falsely elevated to true informed consent - a spurious notion for sure. Conversely, as you point out, true consent can be obtained without any signatures. It's become a farce, in my view. Thanks for taking the time to offer your insights.