Wednesday, January 25, 2017
Hospital consent forms and other stories
Even though I am over 40 (by a long shot) I am familiar with the abbreviation “TMI” (too much information). We are inundated with so much noise, chatter and static. I feel that we are bombarded with information that we must sift through and ultimately delete. The news cycle is 24 hours and hits us from so many electronic sources simultaneously. I am deluged each day with so many unwanted and unsolicited e-mails from organizations that I have never heard of. One of my favorite words on their e-mails can be found when I scroll to the end. UNSUBSCRIBE!
Another genre of information assault is the panoply of warnings and disclaimers that we confront. Of course, we are all numb to them since we have been so supersaturated. I'll prove it to you. The next time you are about to take off on an airplane, the flight attendant will review safety information in the event that a catastrophe occurs. While one might think that folks would be attentive to information that might be useful if the plane loses altitude or is headed for a ‘water landing’; no one is paying any attention at all. Most of us are browsing through the Skymall catalogue which showcases amazing gadgets, such as a device that can dispense feedings to your cat during a week of your absence. For the cat's sake, I hope there won't be a power failure. Moreover, the flight attendants who are issuing the briefings seem more bored than the passengers.
How often do we hear the nonsensical phrase, this product is not intended to diagnose, treat, cure or prevent any disease? In other words, we admit our product does nothing, but please buy it to for your ailing bones and prostate glands.
How often do we hit the I Agree icon, which follows pages of lawyerly small print, just to get to the next page?
We have been over-warned, over-disclosed and over-disclaimed.
While rounding at the hospital, I saw a sign posted on a coffee machine that said “Caution: Liquid is hot.”
Look what fear of litigation has done for us. Prior to ligitomania, we might not have realized that hot coffee is actually hot and might injure of us if we spilled its steaming contents onto us. Now, we are all much safer knowing that hot beverages, which we desire to be hot, are hot.
Of course, these protections extend beyond steaming beverages. If I were in charge, I'd issue rules and regs that would mandate the following warnings.
• Caution: these steak knives are sharp and not intended to remove feet callouses.
• This chain saw is for industrial use by trained lumberjacks. It is not intended as a toy for children under the age of 7.
• This lighter fluid is dangerous and should not be stored in a child's crib.
The medical profession is a part of this game also. Every day, I have informed consent discussions with patients regarding procedures that I have advised them to undergo. These are informal conversations when I try to give patients sufficient information so that they can make informed decisions. This is reasonable and a fundamental part of the doctor-patient relationship.
The hospital, however, is not satisfied with my efforts and requires that patients sign lengthy consent forms, which most patients sign blindly without reading them. For any readers here who have had the pleasure of having enjoyed hospital life, I'm sure that you can attest how many different forms you have signed from the moment you arrived at the hospital door to your discharge. Most patients and physicians regard these signings to be mere formalities, which are intended to protect hospitals, and not patients. If patients actually took the time to read through all of these legal CYA forms, it might grind the hospital to halt. There's not enough time for patients to read and understand all this drivel.
Caution readers! This blog is not intended to inform, enlighten, provoke, challenge or amuse readers. Readers accept all responsibility for any resultant angst or mental torment and hold blogger harmless for any and all perceived damages until the end of time. Click I AGREE.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
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Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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One of the most popular anonymous blogs written by an emergency room physician.