Principle of informed consent unquestionably important

Principle of informed consent unquestionably important

Yulia Warhani, Jakarta

A friend who was admitted to a hospital in Jakarta recently
complained that he felt he was getting worse after taking a
prescribed medicine from his doctor. "You know, I'm getting worse
because of these red-white capsules the doctor gave to me
yesterday," he said.

The doctor diagnosed him with dengue fever. Three days later,
however, the patient became really upset when he was given a bill
for Rp 12 million (US$ 1,275), only for a case of dengue fever.

After I assessed the information about his medication, I then
understood why he experienced such bad feelings while he was
sick.

While it was true that he had dengue fever, he had actually
entered Dengue Shock Syndrome. Unfortunately, the doctor failed
to properly inform him about the diagnosis and treatment. The
doctor neglected the patient's right to informed consent, and
consequently the patient thought he was the victim of
malpractice.

Nowadays, hospitals and doctors are facing growing numbers of
lawsuits from people who are dissatisfied with their services.
Meanwhile, data on alleged malpractice cases in Jakarta in 2003
-- 2004 indicates an increase in such cases.

The three most common forms of negligence were misdiagnosis,
improper treatment or improperly performed procedures, and
improper administration of medication.

The main sources of patient and family dissatisfaction were
nursing and medical care problems, as well as interpersonal and
communication problems. There are numerous complaints of patients
being treated rudely by doctors, nurses or other hospital staff,
with patients and their families not receiving proper
explanations about medications or the diagnostic testing being
conducted, without confirmation or explanation to patient.

Other frequent allegations included abandonment of a patient,
lack of informed consent, and failure to refer or obtain
consultation.

The principle of free and informed consent is unquestionably
one of the most important when it comes to malpractice cases and
medical ethics. It is the basis of the doctor-patient
relationship.

Responsible consent to therapy must be informed consent, which
means the patient must be told the nature of the proposed
therapy, its probable benefits, its possible risks and other
possible treatment choices.

Furthermore, the patient must be free to make their decision
without pressure, persuasion or threat. The health care giver is
obligated to explain clearly all aspects of procedures and
treatment, side effects, advantages, and prognosis. Let the
patients decide for themselves, depending on their capabilities.

A patient must be given sufficient information to make an
informed decision about treatment. Treating a patient without
consent or exceeding the consent may cause unnecessary problems.
Although obtaining written consent is wise, informed consent need
not be written. It is more important to give the patient the
opportunity to ask questions, to explain all significant risks,
benefits, and alternatives, and to document the conversation in
the medical record. Documentation is crucial to avoid disputes.

In the case above, if my friend had been clearly informed by
the doctor, I think he would have accepted the reality and the
cost. Dengue Shock Syndrome is serious, and it needs special
treatment. In some cases patients need to be treated in intensive
care units.

Unfortunately, the situation in our hospitals is unsupportive
of informed consent. The hospital climate does not facilitate the
delivery of information in such a manner. The culture, habits and
obstacles are still with us. Doctors, it seems, do not have
enough time to go into detail about medical treatments because of
time pressures and burdens of the work place. Just imagine, if a
doctor has 10 patients in one hospital, and that same doctor
works for, say, four hospitals. Meanwhile, s/he also has to
attend to out-patients, so time spent doing "informed consent"
may seem an unaffordable luxury.

In addition, in some cases doctors may be under pressure from
managed care organizations to shorten hospital stays, limit the
use of consultants, and avoid expensive ancillary tests.

On the other side, patients may not make enough effort to ask
their doctors questions about their disease, diagnostic tests and
treatments, because they feel intimidated. Many of us perhaps are
afraid to ask questions, or feel embarrassed asking doctors or
any other health care giver about our own health.

It often happens that doctors feel that they will frighten
away a patient if they discuss all possible risks. However, this
can backfire if patients subsequently feel that they were misled
into undergoing a treatment. It is better to inform fully in all
situations rather than face potential negligence claims.

One of the best methods for preventing malpractice lawsuits is
the establishment of a strong patient-physician relationship
based on trust and open communication. Patients who feel that
their physician truly cares about them and has their best
interests in mind are less likely to sue, even if something
untoward has occurred.

It is important to be open and honest with patients in all
circumstances, including discussion about examinations, test
results and prognoses, benefits and risks. Never make guarantees
about the outcome of a treatment.

Good listening and good understanding is needed when caring
for patients and interacting with family members. Likewise,
patients should not hesitate to ask questions.

Every entry in the medical record, whether in a hospital or
office chart, should be dated and signed. Everything pertaining
to the patient's medical care should be clearly documented.

Patient and family dissatisfaction with treatment, as well as
interpersonal and communication problems, are often the triggers
for malpractice lawsuits.

The writer is a lecturer at Saint Carolus Nursing School,
Jakarta.