Source of information for consenting?

[CBG23]

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When I consent a patient for a particular procedure or see them post-operatively on the floor, some common questions I get are:

1.) Approximately how long will the procedure take?
2.) About how long will I have to be in the hospital after surgery? OR... How long will recovery take?
3.) Are there any physical restrictions I will have after surgery (ex. no lifting heavy objects)?

As an intern, I often don't have enough experience to 'just know' the answers to these questions.

I was wondering if there was a reference that you all used that provided the answers to these questions (obviously, every patient is different, but I just want a ballpark idea)? Also, for certain restrictions, a resource that explained the reason behind these restrictions. Any suggestions would be great - Thanks!

 

[Winged Scapula]

The answers to these questions will vary considerably from attending to attending and surgery to surgery. There is not one reference to the answers other than your senior residents and faculty.

Your answer to them is that you are starting your surgical training at this facility with new staff and that the length of time/time to discharge/physical restrictions will depend on the surgeon and surgeon preference and that since you are just learning what everyone's preferences are, that you will check and get back to them.

There is a lot of surgical dogma that doesn't necessarily have a reference. For example, most of my attendings said we could take down the surgical dressing on POD #2: one insisted that it be POD #5 ("the Hopkins way"). Some said shower on POD #5, others 7. Drains out when less than 30 cc, others 25 cc/day. There are certainly some legitimate reasons for the differences, but some of them are just "because I said so".

FYI: I got yelled at for telling a patient they could shower on POD #3 after an exlap; the attending could not tell me why the wound wouldn't be starting to epithelialize by then and what would happen.

 

[Danbo1957]

There are certainly some legitimate reasons for the differences, but some of them are just "because I said so".

Exactly. 🙂

To the OP: Ask your attendings (they'll expect it of you) as to their recommendations for post-op care; write it up, and create your own in-house reference guide. If you want a type of "standard of care", checkout the newest published materials from the NIH, and (no joke) talk to your nurses on what they have been instructed to do concerning any particular procedure.

 

[CBG23]

Thanks for the replies!

Danbo1957: what published materials from the NIH are you referring to?

 

[DarknightX]

When I consent a patient for a particular procedure or see them post-operatively on the floor, some common questions I get are:

1.) Approximately how long will the procedure take?
2.) About how long will I have to be in the hospital after surgery? OR... How long will recovery take?
3.) Are there any physical restrictions I will have after surgery (ex. no lifting heavy objects)?

As an intern, I often don't have enough experience to 'just know' the answers to these questions.

I was wondering if there was a reference that you all used that provided the answers to these questions (obviously, every patient is different, but I just want a ballpark idea)? Also, for certain restrictions, a resource that explained the reason behind these restrictions. Any suggestions would be great - Thanks!

In my opinion, you shouldn't be consenting if you aren't the one doing the procedure/operation. I always do my own consents, and even if I'm so terribly busy that I can't physically have them sign the paperwork, I make sure I meet the patient and answer all their questions as much as I can.

I never liked the idea of scutting out the intern to do my consents, unless I planned on letting the intern scrub in on the case.

 

[CBG23]

A lot of the consenting is done by the interns at the hospital I am currently at - probably not ideal, I know. If I am unfamiliar with the procedure, I do a bit of quick reading to familiarize myself with some of the highlights before hand to make sure I can answer some basic questions about the procedure.

Still curious as to what NIH materials were mentioned above,