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Informed
Consent & Surgery
General rules to follow in consent for surgery and
anesthesia are to inform the patient of common risks
even if they are not serious, and very serious risks,
such as death, even if they are not common. By asking
the patient if they have any specific concerns, you can
invite the patient to let you know of any "special"
informational needs that they may have which are not
obvious to you.
When discussing risks with patients, understand that
mere recitation of statistical risks may mean little to
patients, and it can be helpful to relate the information
to risks which have some meaning for the patient. The
approximately one in 50,000 risk of death during
general anesthesia in a healthy patient can be compared
to that of the risk of death in an automobile accident
(about twice that), as a way of putting perspective on
the information being provided.
Many situations commonly arise around the time of
surgery, in which a patient's ability to make health care
decisions may be, rightfully or wrongfully, called into
question. Some of them include: the premedicated
patient, the patient in labor, the patient under stress,
the patient with known mental illness, the patient with
organic brain disease and the immature patient.
When patients are incapacitated, it is important to seek
the advice of appropriate surrogate decision makers and
others who know the patient and are aware of his or her
usual choices. When such information cannot be
obtained, the physician should try to act in the best
interest of the patient until such a surrogate can be
found.
How Does Medication Affect a Patient's Ability to Give Valid
Consent to a Procedure?
It is common to encounter patients who have received
sedation and/or pain medication prior to coming to
surgery, and it is also common for such medications to
be deliberately withheld prior to surgery in anticipation
of the necessity to obtain consent. When pain
medications are withheld, patients may feel pressured
to consent in order to obtain medication to relieve their
suffering.
In some instances, premedication may actually enhance
a patient's ability to make decisions, by providing pain
relief or relief from emotional distress, so that they can
focus on the choices they are making. Clearly, if
premedication has rendered the patient unable to listen,
to understand their situation, the need for care, the
risks, and alternatives, or to communicate a decision,
then it has negated the informed consent process. But
pain medication should never be withheld from a
suffering patient under the guise of obtaining informed
consent.
Is the Surgical Consent Sufficient to Cover Anesthesia Care?
Principles involving the informed consent process
require that the best available information about
procedures and risks be provided to patients. Just as
anesthesiologists lack the expertise to discuss risks of
surgery, surgeons lack expertise to discuss the nature
and risks of anesthesia. While the surgical consent form
does contain a phrase regarding consent for anesthesia
care, the informed consent process requires that a
separate discussion of anesthesia risks be carried out by
the anesthesia provider.
An Alphabetic Index of Medical Procedures and Their Known Risks
to be Disclosed in Informed Consent...
http://www.intrepidresources.com/html/lmdpfina.html
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Informed
Consent & Surgery |
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