Surgeon wants to get consent

[turnupthevapor]

At a recent OR committee meeting a surgeon brought up a scenario. If he is on the phone with hard to reach family member he would like to get the anesthesia consent for us (if an anesthesiologist is not around)

Curious if anyone could point me in the direction of any literature or previous lawsuits where this has come up. Again he is looking to only do it in rare cases when a family member will not be around for a repeat phone call and the anesthesiologist is not around.

as a jury of my peers what would you say?

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[Wiscoblue]

At a recent OR committee meeting a surgeon brought up a scenario. If he is on the phone with hard to reach family member he would like to get the anesthesia consent for us (if an anesthesiologist is not around)

Curious if anyone could point me in the direction of any literature or previous lawsuits where this has come up. Again he is looking to only do it in rare cases when a family member will not be around for a repeat phone call and the anesthesiologist is not around.

as a jury of my peers what would you say?

I'd be ok with him getting consent.


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[anbuitachi]

our consent form here says surgery and anesthesia consent.. kinda weird so the surgeon is the one who gets anesthesia consent here. though we still always talk to the patient on day off to explain stuff . but in those cases where family member cant be reached , i just write consent obtained by surgeon.

i think the idea is that no one would get anesthesia just to get anesthesia. usually a surgery is also involved.. it'd make no sense if we get consent, the patient agrees, and then says no to surgery consent. so i think its smoother when surgeon gets both.

I'm guessing legally, whoever signed the consent paper under attending/witness would be responsible, since the form does say surgery and anesthesia consent.

 

[nimbus]

A surgeon is no worse than a preop nurse or floor nurse who is usually the one who obtains the anesthesia consent signature for us. I'd have no problem with the surgeon getting the signature. We usually obtain the real consent after the fact when we talk to the patient.

 

[fakin' the funk]

A surgeon is no worse than a preop nurse who is usually the one who obtains the anesthesia consent signature for us. I'd have no problem with the surgeon getting the signature. We usually obtain the real consent after the fact when we talk to the patient.

Where I work, the nurse physically obtains the signed consent paper after verbal confirmation with the surgeon that the procedure has actually been verbally consented for.

 

[fakin' the funk]

I'm a big believer in get your own consent.

In the OP's scenario, in my opinion, the surgeon getting consent is immaterial; the anesthesiologist still needs to make a good-faith attempt to reach this hard-to-reach decision-maker. If the anesthesiologist can't reach that person, then you rely on the fact that the surgery itself was consented for and whatever degree of implication of consent there was for the hospitalization, etc.

 

[Mman]

I'd have the surgeon obtain his surgical consent and then mention that the anesthesiologist will be attempting to reach you at this number to obtain the anesthesia consent and if they are unable to reach you, are you OK with us still proceeding with surgery and not delaying further?

That's not really obtaining consent for the anesthetic, but at least documenting the family member understands that if they can't be reached we won't further delay surgery.

 

[twoliter]

I'd have the surgeon obtain his surgical consent and then mention that the anesthesiologist will be attempting to reach you at this number to obtain the anesthesia consent and if they are unable to reach you, are you OK with us still proceeding with surgery and not delaying further?

That's not really obtaining consent for the anesthetic, but at least documenting the family member understands that if they can't be reached we won't further delay surgery.

This sounds like the best middle ground. I think one issue you could run into is if the surgeon explains one anesthesia plan ("oh, just some sedation," "they'll do twilight anesthesia," or "it will be general anesthesia, you won't remember a thing") when you have a completely different plan in mind. I could actually see that happening somewhat frequently depending on the procedure.

Where I did residency (just a couple years ago) the only time anesthesiologists/residents needed to get consent was for nerve blocks / epidurals (unless that was the planned anesthetic) and nonsurgical cases, such as MRI/CT. (Though we were also in charge of IV contrast consent in cases that needed it. Dumb.) Otherwise, the anesthesia (signed) consent was built into the surgical consent, as someone above mentioned.
Where I was for fellowship last year (a children's hospital), we went from signed anesthesia consents to it being built into the surgical consent.
Obviously, in both situations, we still had to discuss the anesthesia plan, risks, etc. as you would if they were signing a separate consent.

 

[facted]

I'm a big believer in get your own consent.

In the OP's scenario, in my opinion, the surgeon getting consent is immaterial; the anesthesiologist still needs to make a good-faith attempt to reach this hard-to-reach decision-maker. If the anesthesiologist can't reach that person, then you rely on the fact that the surgery itself was consented for and whatever degree of implication of consent there was for the hospitalization, etc.

agree 100%. Some might disagree, but I don't think surgeons necessarily fully understand all risks and benefits of anesthesia types to explain to a patient or family. Relying on them to do so could be an issue. Then again, some places don't even have a separate anesthesia consent. But if your institution does, I would HIGHLY recommend getting your own consent or making a good-faith effort to do so.

 

[deleted171991]

This sounds like the best middle ground. I think one issue you could run into is if the surgeon explains one anesthesia plan ("oh, just some sedation," "they'll do twilight anesthesia," or "it will be general anesthesia, you won't remember a thing") when you have a completely different plan in mind. I could actually see that happening somewhat frequently depending on the procedure.

Where I did residency (just a couple years ago) the only time anesthesiologists/residents needed to get consent was for nerve blocks / epidurals (unless that was the planned anesthetic) and nonsurgical cases, such as MRI/CT. (Though we were also in charge of IV contrast consent in cases that needed it. Dumb.) Otherwise, the anesthesia (signed) consent was built into the surgical consent, as someone above mentioned.
Where I was for fellowship last year (a children's hospital), we went from signed anesthesia consents to it being built into the surgical consent.
Obviously, in both situations, we still had to discuss the anesthesia plan, risks, etc. as you would if they were signing a separate consent.

And that's what matters.

IMO, the best of both worlds is to have the anesthesia consent built into the surgical one, but will all the detailed risks listed. Then, on the day of surgery, one can have the informed consent discussion with the patient about risks/benefits/alternatives, without having to deal with all the paperwork that's distracting, just a few quick notes. Legally, the informed consent is not the patient signing that piece of paper, it's the conversation.

99% of my patients don't read the anesthesia consent they sign at the end of our discussion, just sign at the X mark.

 

[dannyboy1]

Like everything else in our field, if the case goes well then all anesthesia paperwork never sees the light of day. Something happens, and a sloppy consent is just more ammunition for a plaintiff's attorney.

 

[Mman]

Legally, the informed consent is not the patient signing that piece of paper, it's the conversation.

99% of my patients don't read the anesthesia consent they sign at the end of our discussion, just sign at the X mark.

+10000


The only place I've ever worked that had a signed piece of paper for anesthesia consent was as a resident. Nowhere else that I've been was there anything other than a documentation of verbal consent and the malpractice carriers have all been just fine with that.

Consent is the conversation. The piece of paper being signed is meaningless.

 

[Mman]

Like everything else in our field, if the case goes well then all anesthesia paperwork never sees the light of day. Something happens, and a sloppy consent is just more ammunition for a plaintiff's attorney.

If something happens, the written piece of paper is useless.

 

[deleted171991]

If something happens, the written piece of paper is useless.

That is correct, because we live in whinerland, where patients first agree to the best plan and its risks, then they sue you when those risks materialize. And the tort system is set up in a way to favor the malpractice lawyers, not the physicians (or the patients), hence those pieces of paper the patients sign are just to remind them of what was discussed. They become irrelevant, unless one does like smart surgeons, and literally sits down with the patient and points out the essence, paragraph by paragraph, over 5-10 minutes.

 

[jwk]

At a recent OR committee meeting a surgeon brought up a scenario. If he is on the phone with hard to reach family member he would like to get the anesthesia consent for us (if an anesthesiologist is not around)

Curious if anyone could point me in the direction of any literature or previous lawsuits where this has come up. Again he is looking to only do it in rare cases when a family member will not be around for a repeat phone call and the anesthesiologist is not around.

as a jury of my peers what would you say?

Turn this around - if the anesthesiologist is on the phone with the hard-to-reach family member, should he get consent for surgery?

 

[sleepallday]

At a recent OR committee meeting a surgeon brought up a scenario. If he is on the phone with hard to reach family member he would like to get the anesthesia consent for us (if an anesthesiologist is not around)

Curious if anyone could point me in the direction of any literature or previous lawsuits where this has come up. Again he is looking to only do it in rare cases when a family member will not be around for a repeat phone call and the anesthesiologist is not around.

as a jury of my peers what would you say?

I don't know a single surgeon that can adequately obtain informed consent for anesthesia. Simply asking the patient if he's cool with receiving anesthesia does not cut it. No informed consent, no surgery. Otherwise, your just setting yourself up for problems. Their are so many different scenarios I can think of during the process of obtaining consent that can cause the patient's family to change their mind.

If the family member is that difficult to reach, everyone involved in the case just has to make a much better coordinated effort to get the family member on the phone. I've been in a situation where I received a message that the family member is difficult to get on the phone and could I meet the surgeon a specific time to get consent. Shouldn't be to hard.

 

[Mman]

Turn this around - if the anesthesiologist is on the phone with the hard-to-reach family member, should he get consent for surgery?

That's not exactly a comparable situation in most circumstances since for nearly all surgeries, you can't have surgery without anesthesia. But it's quite possible to be anesthetized without having surgery. There is some degree of implied consent for anesthesia with consenting for the surgery that isn't true in reverse.

Don't get me wrong, IMHO the surgeon legally can't obtain anesthesia consent. But I think there is more leeway in terms of implied consent for the anesthesia than there is for the surgery.

 

[anbuitachi]

Turn this around - if the anesthesiologist is on the phone with the hard-to-reach family member, should he get consent for surgery?

I got it plenty of times when i was a CA-0 rotating on surgery =)