Informed consent

[painstop]

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How do you guys perform informed consent in your Pain Clinics. Do you give your patients the "schpiel" directly before the procedure, when they're in the clinic for their normal clinic visit prior to their procedure day (assuming you don't fit them in the same day) or do you allow one of your extenders to provide the patient with the information on a piece of paper they need to sign and don't do any personal consent unless they have specific questions? I know of some pain clinics that do it that last way because they are busy but I'm wondering whether that's really kosher.

I usually tell my patients the risks are "bleeding, infection, headache and nerve injury" since that seems to cover the bases fairly well...nerve injury can be paralysis without saying paralysis. I don't include things like "death" since that is unlikely and not what a "reasonable physician" would include in the consent since the "reasonable physician" argument is often included in any litigation. Also, do you guys include, as alternatives, that "we could simply not do the injection and try PT"?

 

[Tenesma]

consent is signed on the day that we decide to do the procedure - not on the day of the procedure itself - and gets resigned/initialled/dated if >30 days have gone by since consented and procedure date.

since I perform the procedure, I make sure that I go over each potential risk - i do not mention death - but I do mention stroke/paralysis as extremely rare occurences (and that they are more likely to die from a coconut striking their head on their next caribbean vacation)....

doing a consent RIGHT before the procedure, in my mind, is tough... because the patient could argue that they felt co-erced (they got a ride, were nervous, etc...)...

 

[SSdoc33]

i include the words "other rare complications". dont really know what that means or if it covers my ass at all.

 

[Ligament]

I say this line to everybody the day I schedule the procedure:

"There is a risk of bleeding, infection, nerve damage, worsening pain, no effect at all, and in very rare instances stoke, paralysis, or death"

 

[lobelsteve]

Informed consent was once an ethics document that allowed for morally adequate risks and benefits to be explained to the patient so that they could determine if they agreed with the procedure/plan of care.

It is now a worthless legal document. The wording is often mandated by state law. Check your informed consent with your malpractice carrier for updates and changes.

Not having consent doesn't destroy your defense, but certainly doesn't help it. I know of a recent case that went to court and no informed consent could be found. The defense still won (due to an awesome expert testimony).

Having a consent only allows the plaintiff to take every word to task and in no way offers a protection from complications when they occur. I consider informed consent a zero limiting factor. It will reduce the reward by one zero when you lose.

 

[PMR 4 MSK]

Oral informed consent with a printed out FAQ sheet given to the patient at the time we decide to do the procedure. Written consent and brief oral review of the risks/benefits at the time of the procedure.

This process has been approved by our legal advisers and malpractice.

 

[Tenesma]

my malpractice carrier likes visual aides - they suggested adding the following:

"an anatomic model of the spine was shown to the patient. The nerves, spinal cord and blood vessels were pointed out. The needle entry site/positioning of the needle was demonstrated."....

i guess they could argue in court (defending you), that if the patient didn't understand the verbal or the written consent, they must have understood a "needle" going into your "spine", next to "nerves" and "Blood vessels"....

 

[clubdeac]

I wanted to revisit this thread bc not many of you responded. As painstop originally asked, do you guys go over your consent personally with each patient or do you have one of your underlings do it 😉 My staff was doing it but we were recently told this was not kosher. As they are getting on the table, I again ask every patient if they are on any blood thinners or have ever had problems with contrast dye. I guess I could quickly add, "as you were previously told, the risks include bleeding, infx, nerve damage, paralysis, reaction to the anesthetic and death..." before sticking 'em. Thoughts?