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Informed Consent - Don't Sign Until You Understand

Posted Feb 10th, 2009 by Trisha Torrey

Last month, my friend Anna needed minor out-patient surgery and asked me to accompany her.

When we arrived for the appointment, she was handed a stack of papers, told to fill them out, sign them, and return them to the receptionist.

There were insurance papers, health forms, privacy agreements, and information about who was responsible for paying bills.

Then, near the bottom of the stack, she found one that had a few paragraphs that disclosed some anesthesia risks, plus a line for her signature and a date at the bottom. It was titled "Informed Consent."

Anna just stared at it.

"I’m not sure I understand this one," she told me. "What exactly am I consenting to?"

You’ve heard this advice before, "Don’t sign anything until you know what you are signing." Too often we ignore that advice, and the swipe of a pen indicates we understand. But signing an Informed Consent document before you are ready could jeopardize your health.

The concept of Informed Consent is based on state law. While each state legislates it a bit differently, the basics remain the same.  Informed consent requires your doctor to provide information about the benefits, risks and alternatives of any test, procedure or treatment she recommends, before it is performed. It requires you to sign a document which states your doctor has provided that information and that you understand it.

Beyond a legal requirement, it’s simply good practice for doctors to require informed consent from their patients.  Their goal is for your health to improve. If you don’t comply with their instructions, then your health may not improve.  When approached correctly, by requiring your consent, your doctor is making sure you really do understand what your treatment will require from both of you -- his participation and yours, too.

Here are some guidelines to keep in mind the next time you are given an Informed Consent document to sign:

·         First, your signature on the form tells your doctor that she has permission to go forward with her recommended treatment, test or procedure. It makes no sense to give any doctor permission to do anything to you until you understand why it’s being done, what other choices you have, and what could possibly happen to you in the process. If you have unanswered questions, then keep asking them until you comprehend the answers.

·         There is no rule that says you must sign the form when it’s handed to you. Like Anna’s experience, some doctors include the Informed Consent form among the documents that must be signed by patients before they see the doctor. If that happens to you, then just hang on to it until you are satisfied you have the information you need.

·         Finally, recognize that your signature on the form provides no guarantees that the treatment, test or procedure will relieve or cure you, or that you are removing any risk. Unfortunately, medical treatment can never provide a guarantee. But your understanding of why you need the test or treatment, how it will happen, and what the risks and alternatives are, will support its chances of being successful.

Anna didn’t sign the Informed Consent document right away.  Instead she waited to talk to the surgeon.  After a brief conversation with him, she understood exactly what was going to happen, from the local anesthesia, to the pain killing drugs they would give her to take when she got home.

Then she signed the document, and had her surgery.  A few hours later, we were on our way to return Anna home.

It’s true that "informed" and "understands" are two different concepts, but they most definitely go hand-in-hand.

Like Anna, an empowered patient expects both.

 

About the author

Trisha Torrey is Every Patient's Advocate. She is a newspaper columnist, radio talk show host, national speaker, and the guide to patient empowerment at About.com.

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