Does Informed Consent Really Matter?

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The doctrine of informed consent is a bedrock medical ethical principle.  Physicians’ obligation is to present the patient with reasonable diagnostic or therapeutic options with the respective risks and benefits.  Decision-making authority resides with the patient.  While this process sounds straightforward, it can be a bewildering process for patients and their families. 

For starters, physicians – as members of the human species - have opinions on the available medical options. These opinions may be on the basis of medical evidence or professional experience. Is it possible that a surgeon might prioritize an operative approach by virtue of training and experience?  Physicians, like the rest of us, harbor biases that may be unconscious or difficult to compartmentalize.  Certain medical options may not be locally available and might not, therefore, be given strong consideration. There may also be a tendency for a doctor to endorse a test or a treatment that this physician performs, rather than refer to a colleague who is trained in other methods. I am not suggesting improper behavior here; the doctor may truly believe that his or her skill set can meet the moment.  

Do we expect physicians to simply recite a list of options dispassionately?  I don’t think so.  Patients want and are entitled to our best advice.  It is typical and understandable for a patient to ask me after hearing the options, “What do you think I should do?”  I'll be your doctor has had many similar experiences. 

Patients are not medical professionals. It can be challenging for them to grasp the intricacies and nuances of medical treatment. I know this is true, as there are times when we doctors are struggling to navigate through this complex landscape. Imagine a cancer patient – an ordinary person –sorting through different therapeutic options which may last for months or longer, weighing efficacy and adverse reaction data. Sound straightforward?

When my car mechanic, my HVAC guy, my home remodeler, or my attorney offers me advice, I  give weight to their best recommendations. They are the pros.  If they have the experience and the integrity, then I tend to rely upon them.  Yes, there may be some give or take. But I am mindful that one of us is more qualified to opine.  After all, that's why I hired the individual.

Explaining medical options to patients accurately and fairly is among the highest obligations that we physicians have for our patients.  It can be a challenging task, but we doctors must strive to meet the moment.  This is not a process that should ever be approached dismissively or by rote.  The informed consent process occurs prior to a patient affixing his or her signature on a form.   The signature itself is not tantamount to consent.

The day before I penned this post, I advised a patient with a benign disorder of the esophagus to begin a safe and effective medicine. The patient understood the rationale for my recommendation and the risks of not treating his condition.  He simply did not want to take medication.  I was satisfied that his decision was informed, even though his analysis differed from mine.  But I am not the decision maker.  He is.

My patient's response to my medication recommendation.

With some regularity, patients decline my medical advice for a variety of reasons.  This is not a rejection of me at all, but rather an acceptance of the primacy of the patient’s authority to decide his or her medical future.