Monday Musings 9/12/22- Informed Consent

When a nurse co-signs a consent they are only witnessing the patient’s signature on the consent. Not that the surgeon has had a conversation with them about the risks and benefits of having or not having surgery. That conversation is in the H&P, signed by the doctor.

People don’t realize that. They think to be the witnessing signature the nurse has seen the risks and benefits conversation, and been privy to the questions the patient and/or their family has asked the doctor.

We do review the procedure as listed with the patient. But that is not what we are witnessing.

We are only witnessing that it is their signature on the signature line, Or that of their family member in the case of the patient who is unable to sign for themselves due to sedation or lack of mental capacity.

Consent is a complicated subject. And is different depending on where you are practicing.

And one that is not well understood. Even by the ones witnessing the signature of the patient on the legal document.

No abbreviations can be listed. Although I know what a lap is, not everyone does. To avoid confusion the word lap must be spelled out laparoscopy. The writing of lap appy on the consent is not to be done. What should be written is laparoscopic appendectomy.

Laterality is another big one. If there are 2 of a body part, it must be described in the consent with a descriptor, usually right, left, or bilateral.

As discussed before, the reasons for the rules is because someone, somewhere did not follow the rules and something happened that cause harm to a patient.

It is a common misconception that the Hippocratic Oath, recited by all doctors, contains the words do no harm. That part was removed when there was a new translation written in 1948. Some medical schools have their own interpretation of the oath as part of the graduation swearing in ceremony for new doctors.

The phrase do no harm is what many of the doctors and nurses that I have worked with cite as reasons to take action, or not take action, as the case may be. This issue is a sticky one that some people allow to color their actions, especially in medically necessary, but ethically dubious situations.

And then there are the patients who are unable to sign their own consents. This may be for a variety of reasons: age of the individual, mental capacity, decisional capacity, or the ability to make their own decisions, not being conscious, loss of ability to sign among others.

And then the big one: emergencies. This is a situation that arises where not to act or have surgery, would be detrimental and lethal to the patient. In other words, to save the patient’s life. But, oh no! There is no family that is easily reachable by phone. In this situation, 2 doctors may sign. But if one of the doctors is the surgeon, this may lead to ethical questions.

In the operating room, our work is driven by consents. It makes sense that we be as knowledgeable as possible.

Consent law is different in every state. Read up on yours. The life you save or impact may be a patients.

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