When my friend Jennie needed minor, out-patient surgery, she asked me to accompany her. When we arrived at the clinic, she was handed a stack of papers, told to fill them out, sign them, and return them to the receptionist. Included was a document called "Informed Consent."
She 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 in this case, signing an informed consent document before you are ready could jeopardize your health.
The concept of informed consent is based on state law. It 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.
But there’s more to know, 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 else could be done instead, and what could possibly happen to you in the process. If you have unanswered questions, then keep asking them until you comprehend the answers.
As you read through the informed consent document, be sure it is clear and doesn't use any statements that allow them to hedge the care you get. A good example is informed consent for surgery. Any hospital that uses medical residents (who are students) to handle some of their patients, will probably use statements in their informed consent documents that will lead you to believe a full-attending surgeon will do your surgery. However, after you've been anesthetized, you may be handed over to one of these residents to do your surgery. Granted, students need to practice on someone! But if you want to be sure the surgeon you have chosen will be the surgeon doing the work, make sure his or her name is specified in the informed consent document, and don't allow phrases such as "anticipated" or "member of the team" to remain. Cross them out.
There is no rule that says you must sign the form when it’s handed to you. Like my friend’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. If you haven't had the conversation yet, then you haven't been informed.
Also, 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.
It’s true that "informed" and "understands" are two different concepts. An empowered patient expects both.