General Medical Information

Consent

James A. Duncavage
John R. Coleman, Jr.

The issue of informed consent for a surgical procedure in the operating room begins in the office. The Professional Liability Committee of the College of Surgeons states that consent is a continuing education process that results in a joint decision to pursue a specific treatment plan. The otolaryngologist must include the patient in all decisions, which is accomplished through patient education in the office. The use of pictures, anatomic models, and prepared video of the patient’s problem all can be used to educate the patient so that an informed decision can be made by the patient for treatment.

The signing of the consent is usually done at the hospital or day-surgery center the day of the surgery. This setting is not the ideal, however, because the patient is under duress and the surgeon may not have ample time to explain the planned treatment, its risks, benefits, and alternatives. For these reasons, the office is the best setting to discuss consent. We developed an office consent form that covers the main points of an informed consent.

The office consent form lists the planned surgical procedure and provides an explanation of the procedure, including why surgery is recommended. Next, the office consent covers the risks, both common and serious, of the planned procedure. The issue of patient discomfort as a result of the surgery is discussed. The patient then signs the form, acknowledging having had an opportunity to ask questions about the proposed treatment. The patient also indicates that he or she wants to have the surgical procedure performed and checks the box next to the explanation that a change of mind is possible anytime. The patient and the doctor then sign the form and date it.

Planning a patient’s treatment, including a surgical procedure, is not to be taken lightly by the surgeon. For a patient, any trip to the operating room is an experience that brings out fear of the unknown. All the facts about the procedure must be explained, and the patient must be given every opportunity to ask questions and to understand any alternatives to surgery. We highly recommend the College of Surgeons liability/risk management manual for further reading on this topic.