Informed consent question

[Anonymous]

I understand the legal and ethical reasons for informed consent before a minimally invasive procedure or surgery. One thing I find difficult is discussing a procedure or surgery on the day of. I get really squeamish about any trauma happening to my own body, and my anxiety runs high. I have asked providers if I can come in on a prior day to complete the informed consent, and I have been denied. I have also asked providers if I can skip over the details of the surgical procedure e.g. keep things very general as in, "You are operating on my right knee today," and I have been turned down. I close my eyes, breathe deeply, and try to tune out the exact details of the procedure as I am being "consented." To be clear, I read everything sent to me in advance. When I am given the information from a PA or nurse over the phone in advance, I listen. It is just very hard for me to hear everything out in the minutes or hours before a surgery.

Do medical practices really have to do informed consent on the day of the procedure? Do they really have to read over every gory detail even when I insist I understand and specifically ask not to participate in that part on that day?

[Anonymous]

For the most part, yes. And yes, they absolutely have to go over every detail when consenting you. Imagine if they glazed over stuff, you suffered a complication, and then you tried to sue because they never warned you of said complication.

My mom has significant health anxiety. While she is 100% mentally competent, I am activated as her health care proxy. She becomes overwhelmed with information and starts to panic. So I listen to the details and sign all the consents. Is this an option for you?

[Anonymous]

Yes, I’d be happy to have a proxy sign the forms. I asked about prior to a recent procedure and was turned down by the facility.

I will also gladly go over the consent in all its gory detail, but I prefer to do it in the days prior to my procedure or surgery. I proposed that option recently and was also turned down.

[Anonymous]

Anonymous wrote:For the most part, yes. And yes, they absolutely have to go over every detail when consenting you. Imagine if they glazed over stuff, you suffered a complication, and then you tried to sue because they never warned you of said complication.

My mom has significant health anxiety. While she is 100% mentally competent, I am activated as her health care proxy. She becomes overwhelmed with information and starts to panic. So I listen to the details and sign all the consents. Is this an option for you?

+2

Designate a trusted person to discuss these elements on your behalf. But yes, medical providers certainly have to outline the procedure they’ll conduct.

[Anonymous]

Read the stuff in advance. Write down questions if any. Else just zone out as they rattle stuff off.

[Anonymous]

You have to listen. What if they say operation on your left knee but you tune out and agree, but really your right knee has the problem?

[Anonymous]

Anonymous wrote:Yes, I’d be happy to have a proxy sign the forms. I asked about prior to a recent procedure and was turned down by the facility.

I will also gladly go over the consent in all its gory detail, but I prefer to do it in the days prior to my procedure or surgery. I proposed that option recently and was also turned down.

It's weird to me that they wouldn't do this. Did they give a reason? Is it just a big hospital and they can't make process exceptions or things get all crazy?

This is the kind of problem I would drop in the provider's lap, especially if you have one you use frequently.

"I'm not able to do the informed consent at the time of the procedure. It dramatically raises my anxiety level and it's not manageable or healthy for me immediately in advance of surgery. What are my options for doing informed consent in advance?"

Them: "That's not an option, you need to do it right before you go in."

Me: "As I said, that doesn't work for me. We need an alternative. Can we do it via video call that morning or the night before?

Them: "No, that doesn't work for us."

You: "Doing it the morning of doesn't work for me, so what do you suggest?"

etc, etc.

IE, make it their problem not yours? Sometimes I've had a lot of success with this method, particularly when the actual issue is bureaucracy.

[Anonymous]

There is a difference between listening to them rattle off the death, stroke, heart failure etc that may occur and agreeing with what they are doing. When I had multiple surgeries they always keep asking me what's being done. Left knee replacement, etc. Doc even initials the limb.
Right before anesthesia they ask what's your name and what are we doing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, I’d be happy to have a proxy sign the forms. I asked about prior to a recent procedure and was turned down by the facility.

I will also gladly go over the consent in all its gory detail, but I prefer to do it in the days prior to my procedure or surgery. I proposed that option recently and was also turned down.

It's weird to me that they wouldn't do this. Did they give a reason? Is it just a big hospital and they can't make process exceptions or things get all crazy?

This is the kind of problem I would drop in the provider's lap, especially if you have one you use frequently.

"I'm not able to do the informed consent at the time of the procedure. It dramatically raises my anxiety level and it's not manageable or healthy for me immediately in advance of surgery. What are my options for doing informed consent in advance?"

Them: "That's not an option, you need to do it right before you go in."

Me: "As I said, that doesn't work for me. We need an alternative. Can we do it via video call that morning or the night before?

Them: "No, that doesn't work for us."

You: "Doing it the morning of doesn't work for me, so what do you suggest?"

etc, etc.

IE, make it their problem not yours? Sometimes I've had a lot of success with this method, particularly when the actual issue is bureaucracy.

That’s the route I went with in the days leading up to the procedure as I spoke with the surgical coordinator. They were not willing to be flexible. I guess they have enough patients lined up that they didn’t need me to commit to the surgery. Unfortunately, I have an extremely limited provider network through my health insurance. If I wanted the procedure done in a timely way, I had just one health system I could use, and that system had one location with schedule availability.

As I think over my experience, I was curious to know if it was typical or not. If not, I may consider a polite letter to the health system that did the surgery. If it is typical, then perhaps I have some foreknowledge to help me navigate my future medical needs.

[Anonymous]

Anonymous wrote:There is a difference between listening to them rattle off the death, stroke, heart failure etc that may occur and agreeing with what they are doing. When I had multiple surgeries they always keep asking me what's being done. Left knee replacement, etc. Doc even initials the limb.
Right before anesthesia they ask what's your name and what are we doing.

Exactly. I was willing to listen to and repeat back, “You are going to go a laparoscopic gall bladder removal” (not the actual surgery, just an example).

What I did not want to go over was “There will be incisions here, here, and here. We will then insert the scope. After cauterizing the blood vessels, we will remove…” Unfortunately, both the surgical coordinator and the surgeon subjected me to the blow-by-blow the day of. I had read all of this by email and had discussed it with the coordinator the day prior to my surgery. I had also scheduled a visit with my primary care doctor to get information about the procedure. My DH was with me during the consent form signing and also vouched, “I promise she understands.” I even spoke up and said, “I am afraid I will faint if I discuss this in detail” before spending the entire consent process with my eyes shut, doing deep breathing exercises, and fidgeting.

[Anonymous]

Anonymous wrote:Read the stuff in advance. Write down questions if any. Else just zone out as they rattle stuff off.

This is what I do. I read everything before I'm there and have my little panic, and then I don't listen on the day of when they are going through it and just sign.

I have also sometimes asked that they leave the paperwork for me to review and come back in a few minutes. I know this is annoying for hospitals because they need to check it off and they don't want to have to circle back. But if I'm going under general anesthesia, for some reason it helps me feel better to just have a minute before I sign and give it to them. If I feel rushed, then my anxieties will really ramp up and I'll second guess. If they leave me alone and come back, it feels like my choice and that doesn't happen. I've never had anyone turn me down when I've asked.

[Anonymous]

I had my entire colon removed at the Mayo Clinic and in consenting me, they did not go into the level of detail folks here are describing. In fact, the surgeon almost forgot it, said “oops, I have to consent you,” took me back into the room and said “It’s surgery, there is risk of blood loss, the surgery may not succeed, possible outcomes include death” and I nodded and that was it. I am sure I signed a form at some point.

I think docs and practices insisting on the level of detail described above are sadists. Sometimes you have no choice but to have one of them operate on you, but the idea that it is somehow inevitable or required to be done in exactly this way is nonsense.