Managing Patient Expectations: The Process of Informed Consent

The doctrine of informed consent is a necessary part of legal standards of good practice and is essential to good patient care, patient compliance and patient satisfaction. Its also critical to risk management in your practice.

There are two standards that are used to measure informed consent. Some states apply the reasonable doctor standard: that information a reasonable physician thinks is important must be presented to a patient in order to establish their informed consent. More commonly, courts apply a “reasonable patient” standard: that the doctor present the patient with all of the information that any other reasonable patient would want and need to know so that they may make an informed choice about their medical care.

There are different opinions on how to present information to patients, and what types of information to present in order to satisfy the prerogative of good patient care and that also meets the legal standard to protect the doctor. Some doctors believe the informed consent process should be videotaped, as patients often have a different opinion than the doctor as to what was discussed and presented to them. Most practitioners simply document the process in templates and patient notes, which include the process of information presented, the questions that the patient asked, and a description of what the physician can and cannot do. Your process should ensure that all three elements are captured in the patient’s medical record.

Medical practitioners want to be sure to describe in detail their medical observations and recommendations, the surgical procedure, and pre- and postoperative instructions. You should describe what reasonable expectations the patient can have for the outcome, alternatives to their care or the contemplated procedure, and the inherent risks and complications of the procedure. Each of these facets of informed consent are even more imperative when the procedure is an elective one.

In order to improve patient safety and patient care, the informed consent process has to be more than simply checking the box on information imparted; instead, it needs to be a process which seeks to ensure that the patient fully comprehends the procedure and its risks, and that the process of reaching that understanding is documented in the patient’s records. If you are not satisfied that the patient understands each and every one of the elements of informed consent, the procedure should not be performed.