Doctor Urges Caution on Medical Consent

What do you do when a dream ski weekend turns into a nightmare and you or a loved one wind up in a hospital emergency room in excruciating pain from a bad fall?

One thing to remember is, unless a life-threatening injury requires immediate action, stop and ask questions before signing any medical consent forms.

Anxiety and confusion may make you feel rushed to agree to the first thing a doctor suggests. But, in most situations, agreement to a medical procedure should not be automatic. It is a big decision and you deserve to be informed.

“If you have any questions, get an explanation. If you still have questions, get a second opinion from someone with no ax to grind,” said Dr. Ira Gabrielson, chairman of the Department of Community and Preventive Medicine at the Medical College of Pennsylvania.

Elective Surgery

“One of the areas where that comes up very often is any surgery that’s elective,” Gabrielson said, citing the conflicting advice often given to a woman who has discovered a lump in her breast.

“A doctor may say a woman needs radical surgery. Sometimes that may be the safer course, but it is a very complex area, and she deserves a second opinion.”

Gabrielson, himself a pediatrician, recalled a harrowing experience with his son during a family ski vacation at Lake Tahoe. His son, Hugh, then 11, had a bad spill and was rushed to the local emergency room.

“A fellow in a green (surgical) suit comes out and tells me Hugh needs surgery on his knee and ankle,” Gabrielson recalled.

Surgery Unnecessary

“I just didn’t like being hustled, so we drove to the San Francisco area, where we lived at the time, and finally got an orthopedic surgeon who knew about orthopedic pediatric patients,” Gabrielson continued.

The San Francisco specialist determined the boy’s X-ray was normal for his age and surgery was not needed.

“I still get mad when I think about it, and Hugh’s 30 now,” Gabrielson said, adding that other people, understandably, might presume the Lake Tahoe surgeon would give the best diagnosis of a ski-related injury.

Janet Fleetwood, an assistant professor in the college’s Division of Medical Humanities, said: “Very often patients will be asked to sign a consent form for surgery or other medical procedure when they feel least able to make such a big decision. It can be nerve wracking!

Approval Not Automatic

“I feel it is important to let people know that signing medical consent forms should not be automatic.”

The form, typically required by hospitals before major or minor surgery, can explain serious complications some patients have suffered following the same procedure.

Any question about the procedure, Gabrielson emphasized, is a good question.

“Physicians differ an awful lot. Some are very authoritative--’I know what’s best for you’--and others aren’t so damned sure, even though both might be just as capable,” he said.

“Some doctors say, ‘If I tell the patient what all the risks are, I’m just going to scare the patient to death,’ ” he said.

All Surgery Has Risk

“But there is no surgical procedure that doesn’t carry the risk of a serious outcome. Inform the patient with the best information you have, then whatever happens, at least you arrived at a mutual agreement.”

While a consent form cannot shield a surgeon from legal action, Gabrielson said the rise in recent years in malpractice litigation “has helped them realize that information is good for patients.”

On the other hand, some patients may be too traumatized or too nervous to hear explanations of recommended medical treatments.

Gretchen Harris, director of the patient advocacy office at New York’s Bellevue Hospital Center, said consent can be revoked right up until the procedure is performed.

Can Refuse Treatment

“Patients need to know they have the right to refuse treatment or any procedure offered without adverse consequences to the rest of their care,” Harris said.

“Some good questions to ask before consenting are, ‘How is this going to help me? What are the odds of this helping me? What are the possible bad consequences? And what are the alternatives?’ ”.