Informed Consent - Are They Telling Us Everything and Do We Actually Understand It?

[Rein]

In this thread

http://www.adrsupport.org/private-cgi-bin/ultimatebb.cg...t_topic;f=1;t=000559

I posted this statement:

"Many surgeons don't have the time (or inclination) to educate patients fully about their condition and that's not necessarily their job. "

Poncho replied:

"It is actually the SURGEON'S job to answer questions and educate you on his plan of care for you. Especially, when it comes to surgery. It is called INFORMED CONSENT."

Well, I've done some research to determine if I misspoke and came up with this article, which (in my humble opinion) is critically important for anyone contemplating surgery:

http://www.emedicine.com/ent/topic181.htm

After reading that article I've come to the conclusion that Poncho is correct as to the letter of the law and (although I'm incorrect technically) I'm probably closer to a realistic description of most of our situations when it comes down to how a lot of surgeons look at that end of their practice.

Orthopedics and neurosurgery are two of the most lucrative specialties a physician can do, but time out of the operating room is, obviously, much less cost effective (and very wasteful if it isn't spent well). Spending a lot of time with each patient in educating them about all the nuances of their case is probably not their best use of time but still required by law. I'm inclined to believe that a lot of surgeons spend as little time as possible with the patient once they've completed their assessment and would prefer to go straight to the cure rather than waste time answering the same basic questions time after time. This would account for Dianey's experience and that of many others.

I think those of us who have found surgeons who actually spend quality time answering all our questions in an unhurried fashion, replying to phone calls and emails personally, etc., are very fortunate and in the minority. For the rest of us, education, education, education!!!

Reading the above Informed Consent article really brought home to me how vitally important it is for every one of us, no matter what our background prior to our injury, to spend as much time as possible learning every single detail pertaining to our case in order to fully understand what has happened to our body, what's going on with it now and what options we have for the future.

[sfmcfar]

Interesting. I've tried for over a month to get a simple question answered by my surgeon. Have left a least a dozen phone messages with his secretary. Nothing.

[NCFUSED]

I guess I consider myself lucky....

My Neurosurgeon not only went into great detail about my surgical options (Charite vs. Fusion), he pulled out models of the spine with the hardware for both procedures, then did it all again when my wife had questions. Then formed a plan "a" and "b" with me in case I was rejected by Insurance for ADR.(which I was)

[Fortitudine]

You are a lucky man, NC! We are so short of NS here that you really have to work to get questions answered. As for dialogue, well... My NS idea of informed consent is to describe the procedure in 10 words and then list off the risks, I guess so he's protected in case of litigation.

Dianey, I'd try to find someone who has more on the ball, both in terms of communication skills and experience. As the others have suggested, do your research. But even then, don't make assumptions. Go in prepared with a list of questions, and try to take someone helpful with you.

[Poncho]

Rein,

You paint a very realistic picture of what commonly happens with many surgeons (not all, but many) that wiggle out of their obligations to explain what will be done in the patient's upcoming surgery - regardless if it is spine, abdominal, neuro et al. As a nurse preparing patients for surgery, there have been times that I have went many rounds with some surgeons trying to get out of explaining procedures to patients and even refusing to sign the Surgery consent form. Exactly why they do this - I really don't know. In some cases we had to play "hard ball" - No informed consent and signed consent form - NO SURGERY! - I'm glad that I don't have to deal with this much anymore.

[NCFUSED]

Fortitudine,

Not completely, I went thru an Orthopedic Surgeon that gave me @ 2 minutes each visit.and a Neurologist that kept telling me to take more drugs and PT and it will go away.

The Neurologist then sent me to her partner, another Neurosurgeon, that told me he could explain what was going on, but I wouldnt understand. At that point I understood it was time to find another Doctor A friend recommended my current Neurosurgeon....

It is our health, we should never take no for an answer.....

[Harrison]

How sad (but true) this thread is!

PS: John, I didn't know I had fusion cages named after me...

[ans]

My informed consent was very detailed and associated risks were put in a hierarchical order - although percentages of risk were not assigned. Much is done for legal purposes obviously but I practically gave up on having some questions answered. Naturally, I chickened out of two-level ADR surgery.

[NCFUSED]

Sorry,

My mistake (one too many Vicodens..haha)
I am the proud owner of Harrington Rods / Cage
not Harrison....but with all the good work you have done here, maybe one of the Big ADR manufacturers will name a device for you!!!

[David]

For what it is worth, I think it depends on the specialist in question.

For example, when I decided that I wanted ADR, I told the first Ortho that I went to that I wanted ADR.

After the necessary tests (discogram and more recent MRI), his surgical/scheduling assistant started to describe the nature of the procedure. Within 15 words I knew that he was describing fusion, not ADR.

*Then*, and only then was I told that his office hadn't learned the procedure yet, and that I should wait 6 months and then come back.

Uh, no, thanks. Another ortho and neurosurgeon later (and 5 consults via ***), I am now working with Dr. Yue in CT.

Edit: 2nd story, involving the same ortho. Because I didn't know any better, and didn't think to ask, when my 1st ortho performed the discogram, he didn't really produce any results. No discogram films, no CT scan. The only thing he produced was a written report. Because of my lack of knowledge (and to a certain extent due to his lack of disclosure), when I went to my next neurosurgeon, I had to have another discogram performed.

David