The risks and benefits of not receiving or undergoing a treatment or procedure.
In turn, your patient should have an opportunity to ask
questions to elicit a better understanding of the treatment or procedure, so
that he or she can make an informed decision to proceed or to refuse a
particular course of medical intervention.
This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states."
Unfortunately, the above ethics code is not being used...at least not completely.
Now before everyone thinks that I'm bashing the AMA, I want to say that nothing could be further from the truth. I applaud them for their efforts to provide better communication and protect their patients, members and malpractice insurers. The issue is that providers who adhere to Informed Consent , both medical and alternative providers, only provide partial information.
In other words... it's biased.
Here's what I mean. Let's take one of the most common interventions in maternity care. Induction. You could probably do your own poll and find that in your immediate circle of friends and family, the majority have had, are having or will have their labor induced for various different reasons. I won't get into when an induction is medically appropriate or when it is just elective. I just want to know how many of your friends and family know or knew all of the risks and benefits of an induction. My guess is probably few to none.
Many medical providers will inform their patients of all of the benefits of an induction and the risks of NOT having it done. On the flip side, many alternative providers will inform their patients of all of the benefits of waiting for labor to start on its own and the risks of NOT waiting. So who is right? Both of them will make great arguments about the benefits of their suggestions and the risks of not complying. However, both are biased. Informed Consent is only protective when ALL of the information is being presented without bias. How can a patient make an informed decision without having complete information of the risks and benefits of all the options out on the table?
We continually see fear of litigation on the forefront of every providers mind.
A patient comes in with a problem and expects their provider to decide what
course of action needs to be taken. By letting the provider choose what's best
for us, it frees us of any responsibility. If things go wrong...we can and will
sue them! No wonder our insurance premiums and medical malpractice costs are
through the roof. Not to mention the position this puts our caregivers in. Many
of them are forced to make decisions based more on litigation than the actual
need of the patient. Including unnecessary testing.
So in the case of induction, what would Complete Informed Consent information contain?
Benefits to both mother and baby of an induction
Risks to both mother and baby of an induction
Benefits to both mother and baby of waiting for labor to start on its own
Risks to both mother and baby of waiting for labor to start on its own
If the patient has weighed their options and chooses the option that is not offered by her provider, it is that providers legal and ethical obligation to refer that patient to a provider who can best meet those needs. What a great way to finally encourage collaborative practices between medical and alternative models of care, which we all can agree would save money, time and would be in the best interest of the patient.
Interestingly enough, the pharmaceuticals companies follow the Complete Informed Consent guideline to a "T". In a 30 second commercial they will take 10 seconds to tell you how great their pill is and the other 20 seconds to tell you about how it might harm you or even kill you! If the consumer knows the risks and still chooses to take it, then it's much harder to be held liable. Though the drug companies sometimes get a bad rap, I gotta hand it to them for at least providing complete information about their product, allowing the consumer to have all of the pros and cons so that they can make an educated decision about whether the risks outweigh the benefits.
So while President Obama works out the health care reform
and budget details, maybe he should take a look at something that is already in
place, something simple...something FREE. We all have the right to be protected
by Complete Informed Consent as do our caregivers and insurance companies. We
all just need to ask for it.
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