So, here we are at my first blog entry and I promised to write about my recent health care experience.  For those worried that this text will be accompanied by revealing digital images, don’t worry, the blood and guts have been edited out.  Actually, there is probably not much voyeuristic interest in the procedure per se, so let’s not waste time on those details.  What was eye-opening for me was the experience of being a patient more generally and the lessons that come out of that experience.

Now, I have been a patient before.  Over the years, I have had three different unrelated elective surgical procedures – each at a different hospital and all with favorable outcomes. That hardly makes me an expert on the patient’s perspective, but at least there is some experience from which to draw.

There were several aspects about the recent episode that made a big impression on me. First, on my list is the whole issue of informed consent.  This is the part of the encounter during which the doctor and patient discuss the procedure, the caregiver’s experience with the procedure, the expected beneficial effects, and the potential complications.  As the name implies, the process entails two major components: the delivery by the caregiver of adequate information about the treatment and the voluntary agreement of the patient to participate in that care.   The signing and witnessing of a written agreement attest to the fact that both of these requirements have been fulfilled.

The procedures around informed consent have evolved over time, based largely upon medical ethics and legal judgment.  Since I am neither an ethicist nor a legal scholar, I am on shaky ground here.  Let’s just say that the recent experience of being a patient has caused me to rethink my assumptions about how much information must be given to the patient.  Before this episode, I was convinced that the more information provided to the patient, the better.  That is to say, the physician should always err on the side of providing as full an account as possible of the likely and the unlikely outcomes.  By the way, I have found that this theory applies equally well to the consumption of Thin Mint Girl Scout cookies – the more, the better.
As with Girl Scout cookies, stuffing oneself with information can definitely have its downside, however.  In the case of my informed consent, my physician, a wonderful doctor at the Medical University (whose name I will not use since it seems unfair to give him exposure here without getting his informed consent), spent an hour going over with me exactly what would be done, why it would be done, what were the intended outcomes and what complications might arise.  It is pretty amazing that in today’s health care environment, a doctor would spend an hour of non-billable time with any patient.  OK, I am the president of the Medical University, so it is possible that the doctor spent a bit more time with me, but the staff assured me that this with the routine preparation given to all patients undergoing this procedure.

In many ways, this was the ideal way to deliver an informed consent.  If, heaven forbid, something did go awry, at least I would have been warned in advance about the potential risks and agreed to proceed acknowledging those risks.  The burden of responsibility then falls directly on my informed and agreeable shoulders, as long as the physician performs his or her work without negligence.

The goal should be full knowledge on the part of the patient of all of the risks, shouldn’t it?  That seems to be the prevailing view of the courts, and of course, the legal viewpoint drives medical practice, since no doctor wants to expose him or herself to litigation.  What could possibly be wrong with that model?  Maybe nothing is wrong with it, but let’s think about this and come back to it tomorrow.