Wednesday, May 27, 2009

Informed Consent

All health care providers are supposed to be using Informed Consent (IC) in the office. At the root, IC is about each person being able to make their own health care decisions, and not having things forced on them by a health care provider. Legally there are many parts to IC, but the name implies the two biggest: Information/Informing and Consent.

This is from the AMA website, and is a nice summary of the process:

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

  • The patient's diagnosis, if known;
  • The nature and purpose of a proposed treatment or procedure;
  • The risks and benefits of a proposed treatment or procedure;
  • Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
  • The risks and benefits of the alternative treatment or procedure; and
  • 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.

It sounds great, right? And it is - when it's actually used.

What isn't recognized in far too many offices that I've seen is the right of the individual to make a choice - to consent or not consent to a procedure once they have been informed of the risks, benefits, and alternatives. I think the place that this is most evident is in pediatricians offices with vaccinations.

This particular post isn't about vaccinations (I'll save that for later), but they are a good example of where IC breaks down most often. I've heard about parents getting kicked out of a pediatricians office if they weren't following the CDC vax schedule to the letter. I've seen firsthand how the risks of vaccines can be minimized to maximize compliance and cooperation. And I've heard about the issue of IC being bypassed entirely when someone other than a parent brings a child in for shots and no questions are asked (that particular incident will likely result in an entire post at some point).

There is, too often in my opinion, an attitude from many doctors that what they are selling is all good, no bad, and so important that their services trump informed consent. This is a scary path to start down, because if we have no say at what gets put into or done to our bodies, who are we giving that right to? The doctor? The government? The AMA? The pharmaceutical companies? Someone else? Where does it end?

In the end, we are each responsible for our own health. We can still choose what to put into our bodies and what to do to them and have done to them. Policies like IC are crucial for us to be able to keep our autonomy! So the next time you go in and see any health care provider, take your health back in your own hands - ask questions, demand answers, and exercise your right of refusal. Just because a perscription is written, it doesn't have to be filled. Just because a procedure is recommended, it doesn't have to be performed. If you don't feel right about something (and yes, I'm fully aware that this can include the services of a chiropractor), ask questions until you do, or refuse the procedure.

Your body. Your health. Your responsibility.


  1. There are advantages to being a complete control freak... :) I ask questions, double-check, do research, and have been known to smile and nod and not fill a prescription.

    Interestingly, I find that I do this more for myself now that Juby is in my life. In exploring options for dealing with her health issues, I have occasionally found myself standing in opposition to the vet, and she has prospered as a result. This has made me more conscious of my own health options. I wonder if parents have the same experience regarding their children's health.

  2. D - unfortunately, it's not true often enough. I know of far too many parents who are bullied by their pediatricians into following whatever they recommend that day, rather than actually examining the issue from all sides and being allowed to make a choice. And while I am especially critical of pediatricians (since as parents, we are already accepting the responsibility of IC for another person), it happens in health care offices all over. I think at least part of it stems from the "God Pedestal" that many doctors are placed on.