Read the Fine Print:
Before you have any invasive diagnostic or treatment procedure in the hospital, you will be asked to sign a treatment consent form. Legally, treatment consent forms are used to obtain your informed consent. Informed consent implies that you know what the form says, you completely understand what the procedure is all about, and you are aware of any risks involved. In most cases, your doctor will be the one who explains the procedure to you and who will provide you with the consent to sign. Just like with any legal contract, you should read the fine print of the Terms & Conditions of Service. Do not let anyone rush you through this process, pressuring you to sign something you haven’t had time to digest or understand. You need to know what you are consenting to and what the terms of your written consent means to you as a patient.
In many teaching hospitals, attending physicians may be assisted by medical students, interns, residents and postgraduate fellows in the care of their patients. If you sign a consent that has this in the fine print, you are agreeing to treatment by these persons while under the direction or supervision of the attending physician. While this is not necessarily a bad thing, as residents, interns and students need to refine their skills, you should be aware of this fact.
Keep in mind that direction and supervision have distinct meanings. If the attending physician is directing that only requires that s/he be available for questions. By contrast, supervising requires that same physician to be physically present and personally overseeing the care.
You Can Alter Consent Forms:
If you have any doubts or concerns about your attending physician not being present to supervise your procedure, you may alter the form to read: “I agree to treatment by residents and interns, but expect such persons to be under the direct supervision of my attending physician.” Be sure to initial and date that alteration.
If you or a loved one are having surgery, and you want to make sure that your surgeon is actually performing the procedure – or at least that s/he will be in the operating room – you need to take a close look at the Authorization for Surgeryportion of the consent form. Be sure that your surgeon is the primary surgeon in the operating room and the one performing the surgery.
Surgical consent forms may include some fine print which states : “I authorize ____________________M.D. and any other physicians or associates as s/he may designate ….to perform my surgery.” If you sign this consent as is, you may very well end up having a resident operating on you. To avoid this from happening, delete “other physicians or associates” and insert the word “ONLY” in front of your surgeon’s name. Be sure to initial and date the alteration.
If you have made any alterations to the consent form, be sure to note this when you actually sign the consent. Where the form says “I have read, understood and agreed,” write in “with alterations as so noted above.” Be sure the staff knows what your alterations are. They can only follow them if they themselves are informed.
Share Your Concerns With Your Doctor:
The best way to handle any informed consent concerns is to speak directly to your physician about them. Let your physician know that you desire to alter the form well before the surgery. Have a discussion with your physician to lay out your expectations if you want him or her to be present for, and personally direct, all aspects of your surgery. Ask your physician if a resident will be performing any part of your surgery and what the experience and competency level of the resident is.
While no one wants to be labeled a “difficult patient,” the bottom line is you do want to have some control, and you can do that by making your concerns known in advance. Since so few patients do use their voice to assert their rights, the hospital may find your desire to make alterations to your consent a bit unusual. That’s okay! Never forget that you do have a voice and you are allowed to use it!
All too often, we hear stories about a patient whose wrong leg was amputated, whose wrong eye was removed, whose wrong shoulder was operated on. Most larger hospitals now require the surgical team to have a conversation about the site being operated on and to mark the proper surgical site just prior to the start of the surgery. BE A PROACTIVE PATIENT. To avoid any surgical confusion, mark your own surgial site with a large “X” using a permanent marker before you arrive for your surgery. Better to be safe than sorry.
Anecdote:
My husband signed an informed consent at the surgeon’s office a week before surgery to remove a herniated disk in his neck. The procedure he consented to was for the surgical removal of the herniated disk between the 3rd & 4th bones in the neck. When he was asked to sign another consent form on the day he arrived for the actual surgery, the consent form indicated that the disk being removed was between the 4th & 5th neck bones. I refused to allow him to sign the form until the surgeon arrived and confirmed the location of the disk removal. While the pre-op team wasn’t happy about the delay, I wasn’t about to consent to let them make 2 incisions into my husband’s neck because of any confusion. I had a voice… I used it to advocate for my husband.
” Informed Consent “- 5:04 minutes