If I look back on 40-something-years of training and practicing medicine, I can certainly think of many things wrong with “the system.” But there’s so much positive, that it outweighs the negative, resulting in an amazing and wonderful career path for most doctors, and good treatment for their patients. That certainly was the case for me.
But there were things. Things that drop the scale a little. And one of those things was the Informed Consent. I don’t know when this became a thing, but I do know that in my residency training, the need to obtain informed consent was drilled into our heads. We must get informed consent for any and every procedure we do. If we don’t, all sorts of bad juju will come down on our heads. We receive reams of warnings and counseling from our peers, our medical societies and our malpractice insurance carriers. The doctor must do the consent. You can’t allow nurses or physician assistants to do it. To be honest, despite having had multiple successful operations, I can’t remember any surgeon ever reviewing the actual consent with me. Maybe they assumed since I’m a doc, I should know. And to be clear…I do. But I never read the consent. I sign it like I do all those software update consents, and all 63 of the pages I signed when we bought our house. Squiggle, squiggle, squiggle.
The first time I went to the ER in private practice, was the last time I literally reviewed the actual consent with a patient…like went through the consent…the piece of paper. I met a lovely little, 93-year-old lady with a broken hip, for which she needed an operation. I told her my plan…frankly, the only plan for her. And then I dutifully went down the litany of potential risks and complications she might suffer. She put her tiny little hand on my arm and said, “Oh honey, you’re scaring me,” at which point I told her not to worry. I was going to take good care of her. And I did.
Then I thought about the fact that informed consent, on a person who was going to have that surgery no matter what, was really not that informative, and it served only to scare the person. It would make those last moments before surgery filled with negative fears and doubt, never mind the removal of any positive juju or chemical effect in her brain. Better to have put MY big warm mitt on her tiny arm, and said, “Everything’s gonna be okay, and we’re going to get you up and walking right after your operation.” Imagine the effect on her dopamine, oxytocin, serotonin (the happy hormones). Would that affect her healing and rehabilitation? Well it couldn’t have hurt.
After that, I had a little short consent spiel for elective operations, and unless asked, never discussed risks and complications with trauma patients (sorry malpractice insurance company attorneys). I asked them to read the consent. Most looked at it and made the squiggle. “Go for it, doc!” Never have I had a patient cancel surgery after reading the consent. Some patients kind of laugh at it…if they even read it.
I truly believe it’s time to allow doctors to delegate the giving of the consent to someone else. Allow the patient to simply read the consent if they wish to, and ask questions if they have them. I don’t know of any lawsuit in which the doctor was saved by the consent. If the doc commits malpractice, should the consent save the case for them? If they didn’t commit malpractice, but didn’t actually read the consent to the patient, should they lose a frivolous lawsuit? This is all legal razzmatazz. When considering surgery, or any treatment for that matter, all the positive chi from the cosmos should rain down upon those undergoing the knife and those wielding it.
Please know my friends and former patients, that your doctors are doing the best they can for you. They are well-trained and have a lot of experience by the time they get to lay hands on you. They are thinking about what they would do if you were their mom, sister, or BFF. They are trying not to think about infections or death. They are visualizing an operation that will go as well as it possibly can. They are trying to be positive too!
What do I do when I have to have surgery on myself? I ask all the questions which come to my mind in the doctor’s office, and not on the day of surgery. I try to stay in a positive frame of mind during those visits and on the day of surgery. I smile. If appropriate, I try to have a laugh with the doc. I follow directions! I arrive at the surgery center on time! I bring my cheerful husband with me…and not some scowling attendant, giving the surgeon the stink-eye. (Leave those folks at home). Then I take all those forms and start squiggling. Somewhere in there is that Consent.
And I place myself in my doctor’s good hands.
What a coincidence that I received this on the day before my total knee operation! Yes after almost 4 years of doing the Synvisc injections they no longer work and X-rays show I am bone on bone on my left knee. So I will be signing the consent form and probably not reading most of it either but I appreciate your perspective and agree! Sure miss you not being in the office but I know Dr. Tyler Goldberg will do a great job and he sang your praises by the way! Happy belated birthday on the 17th too! Hope you are enjoying your retirement! Janis Fritsch
You’re in good hands and can look forward to getting better!
Thanks for your perspective. As for the lady having Dr. Goldberg fixing / replacing her knee, he did an awesome job on mine 12 years ago. Still working and going strong, except for kneeling on a floor, kneeling on something with a lot of cushion (i.e. sofa, bed) is ok.
Ty for this , ladydoc and survivor of a lateral mall osteootomy & allograft 10/13
Glad you have “survived,” and hopefully making progress!
How we miss you !!
Miss you too!
I wish you could be cloned! Seriously, I’m so appreciative of your willingness to be real and share practical, nurturing insight Dr. Bergen. Bless you.
Thank you for following my blog. I will continue to share helpful information with you!
Good information for us oldsters. I read all of your posts and love your thinking. Im going to put this in my file to read to others, including myself. Thank you for being you, Dr. Bergin.
Words of wisdom!
Thanks for helping Jerry over the years. We will miss, but know you have handed us over to another great doc.
Thank you Dr B. I always look forward to and enjoy reading your articles!
Charlotte Ed Yeisley
Ed & Charlotte Yeisley MISS YOU SOO VERY MUCH!!!!
Miss y’all too. Haven’t been out to Kovar in a while. I’ll try to stop by next time I get out there.
Before my hip replacement surgery (Dr. Saldhana was great), I actually read the consent and had questions and objections. I asked my questions of the staff and was told not to worry about it, it didn’t apply to me…then why was it in there? And I was also told that signing it was not optional. So sign on the dotted line or no surgery. Is this really fair?
Karen Dougherty Hawkins
I agree. Wish you could be cloned. Dr. Bergin,
Which doctor should I choose to give me the knee injections you were so good at giving?
With in office procedures I as a nurse have reviewed the consent forms with the patients prior to the doctor’s arrival. I worked for a dermatology doctor that would get down right testy if the paper work was not completed by the time he was ready to do his part –
The more complicated surgeries have traditionally been done by he who is doing the surgery. I always just assumed it was that way because it takes an MD to read off the usual list of complications.
I do agree trauma patients don’t need added trauma especially if surgery is the only logical choice. Besides who is paying attention to blah blah when they have a bone sticking out or a hip out of sorts.
You are missed
Thanks Tammy. Appreciate your thoughts on this.
A little late chiming in but how appropriate that this is the week of Thanksgiving – I am so grateful for you and I too wish you could be cloned, as well as the GP that cared for me from childhood til my 60’s. Both of you have a particular gift of straight talk, common sense approach and obvious love for your patients. You never had to treat me for anything more than knee injections, which by the way are working wonders, but I always felt confident that when I needed surgery I would be in good hands. When and if that day comes I know you will point me in the right direction. Miss you and SO happy you are being rewarded with well deserved retirement. God bless!
Thank you Carol! I always like a nice compliment, no matter when it comes! We do miss our old primary care docs, don’t we. Things are just not the same. They can’t be. Different times. Electronic medical records. I’m glad you never needed an operation, and that the shots helped. Thanks for reaching out, and following my blog! Have a wonderful holiday season.