Consent: Not a Waste of Time

After a couple of recent cases, I began to think more about the consent process. Prior to these surgeries, as I was pre-oping my patients, the hospital staff would ask me to sign new consent forms. What I found striking is the fact that the staff didn't seem to care about what I said to the patients, but rather they simply wanted a signed piece of paper. To the hospitals' defense, one could argue that the staff assumed I had already spoken to my patients in detail prior to their surgeries. Despite this, my situation highlights the significance of the consent process.

For hospitals today, functioning in the world of documentation in order to prove compliance with state and federal laws and protection from legal attacks, their motivation will be to simply have the appropriate paperwork complete. For us as healthcare providers, the consent process is so much more important. Unfortunately, over my many years as a podiatrist, I've seen our trainees either not understand the importance of or disregard the full process of consent. To that end, let's talk about the consent process and how to make it successful for both provider and patient.

Purpose of Surgical Consent Process

First, we need to understand the purpose of the consent process. As a provider, you are educating your patient about the various factors that have to do with his surgery. Remember, your patients don't know much about the surgery you're about to do – nor should they. Who's their doctor? Not them. Providers need to understand that the consent process should educate the patient.

It's All About Education

Second, understand that consent is more than simply signing a form. Since it's about education, the provider should focus on explaining the surgical procedure itself, why the surgical procedure will occur (the indications), any alternatives (including why you might not have utilized certain alternatives), and the potential risks of the procedure.

The Patient's Chance to Ask Questions

Third, and perhaps most important, the consent process functions as a dialogue – not a lecture – in which the patient is free to ask questions in order to fully understand the situation.

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In some states the acronym PARQ is used, which is a helpful mnemonic to cover all pertinent details of this discussion.

Here are some tips to help you with your consent discussion:

	1.	Have a real discussion. Don't just have the patient sign the form and move on. That's not consent
	2.	Take extra time. A thorough consent takes time, which can wreak havoc on a busy office. My consents for elective surgery typically take 45 minutes (including the preop history of physical) during which I explain everything about the surgery, but ask more than once if the patient has questions. Remember, some of our procedures are highly complicated and may take time to sink in to the patient's mind. I usually do my elective surgical consents as a repeat office visit. This gives me time to complete paperwork beforehand while getting to know the patient that much better.
	3.	Have an appropriate consent document. Click here for an example of a somewhat detailed consent form. Notice that this consent form includes not only the stated procedure but also a patient information letter relating office policies, a visual representation of the surgery (pictures are worth a thousand words), a checklist stating all pertinent issues were covered, and signatures for each page. This is somewhat cumbersome, but is much better than a one-page form that provides very little detail to the patient and no protection from the lawyers.
	4.	Watch out for red flags. Use the consent process to screen for any concerning behaviors and walk away from any elective surgery if noted. For example, some time ago I saw a paraplegic patient in the hospital with lower extremity ulcers due to fixed ankle equinus (they had never been braced). The first question out of this patient's mouth when I broached the possibility of surgery was about receiving pain medication. This question was all I needed to know they would be a bad surgical candidate.
	5.	Document. Document. Document. Remember, documentation is protection during a lawsuit. Not only do I document the pertinent issues on the consent form, I also include a statement about the specific risks of the procedure in my operative report.

Better patient outcomes is something all of us seek at all times, and it starts before any procedure with an appropriately detailed consent discussion. Keep in mind the cardinal importance of the consent process and you won't go wrong.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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