Informed consent-‘da Vinci code’ for our safety in empowered patient’s safety

Abstract

Respect for patient safety and quality of care improvement in laparoscopic surgery drives us to better ourselves perpetually. The same concerns, however, are becoming powerful bargaining tools in the hands of politicians, lawyers, insurance companies, and business tycoons [1]. We face unhappy patients, reluctant payers, and the stick of shifting regulations, with safety and quality concerns dangled like a carrot. We need to ponder why we have allowed ourselves to be boxed in by such a situation? Society’s yardstick for our performance and hence our reward is the outcome of the operation we perform [2]. The outcomes of our operations are at times unpredictable, causing personal regret despite heart and soul put into the care [3]. Also we lack consistency in reporting outcomes, and fail to practice what is preached [4]. We have been seen as reluctant to adopt critical incident reporting systems that have been advocated much earlier [2, 5]. A systems-based approach is not only a requirement imposed on us by an informed society but also a safeguard for us when things go wrong. The practice of evidencebased medicine is a basic tenet of such systems, informed consent being the very beginning of this systematic journey. Any hiccup in this journey is a potential stick in the hands of regulators. It prompts the financial fat cows to get us sign on a dotted line, exhorting us to be content in remembering that surgery is a calling with personal satisfaction of a job well done [1]. They envy our profession, the only one that has all three ingredients of the good life: learning, earning and yearning. The article by Neary et al. [6] addresses the issue of informed consent in a basic manner, raising some very pertinent and disturbing questions that demand a response. It reminds us that ‘‘informed consent’’ is not truly informative, participative, and voluntary from the patient’s perspective, or why would a significant number of them view it as a ‘‘disclaimer’’? Why would they see it as a protective mechanism for the provider only? Why would these perceptions cut across levels of maturity and gender? And why should such a perception be at cross purposes with the ‘‘patient questionnaire’’ and ‘‘staff questionnaire’’? The last question is an answer in itself and answers the preceding questions. Differing perceptions indicate either vested interest or failure of the communication process. Either way it contradicts the spirit of informed consent. This study holds a mirror to us. Our intentions are always pure and our dealings precise. In fact, surgery is the highest adjective used for anything done precisely. Our care, knowledge, judgment, and technical capability are hallmarks of precise clinical care. Probably, we should accept in ‘letter and spirit’ that informed consent is not merely getting a patient to sign a form. We need to give credence to the perceived vulnerability and helplessness of patients and avoid any coercive moments. We need to be holistically conscious of the social, cultural, economic, and educational plurality of society and increasingly less fiduciary in our dealings. We should not use the jargon of ‘‘reasonable physician standard,’’ ‘‘reasonable patient standard,’’ or ‘‘subjective standard.’’ We should rather empathize with the patient and try to harmonize our thinking process with his or her intellectual and mental frame. We should not hypothesize much about the quantum of information being sufficient or B. B. Agarwal Sir Ganga Ram Hospital, New Delhi 110060, India