Volume 27 • No. 4
Questions answered on informed-consent policy
Revision to professoriate changes result in new "adjunct faculty" designation
New policy clarifies decision-making on admission of ED patients
Patient safety program cited as national model
Architect of Trauma Program navigated his career through twists and turns
Momentum builds with construction projects
Questions answered on informed-consent policy
The hospital's revised policy on informed consent, which took effect last month, has prompted a number of questions from physicians regarding implementation details. The following Q&A summarizes the revised policy and addresses the most common questions. The next issue of Medical Staff Update will include a similar Q&A regarding the Consent to Photograph form.
Q. How is the revised informed-consent policy different?
A. Under the revised policy, the physician - not a nurse as has been done in the past - must have the patient sign the consent form, in which the patient acknowledges that the physician has discussed the risks, benefits and alternatives to the procedure. In most cases, the form should be filled out at the time of the informed-consent discussion. Furthermore, the physician must sign the same form as the patient, not a separate "attestation form" as has been done in the past.
Q. When I see a patient in clinic and recommend an operation, I generally include a discussion of the risks, benefits and alternatives and I document this in my clinic dictation. Not infrequently, patients will think about their options and decide later whether to schedule the procedure. If the patient decides to have the operation, he/she returns for a history and physical, lab tests, anesthesia evaluation, and to sign the consent form. Do I need to be present at this visit and sign the attestation portion of the form at the same time as the patient?
A. In this scenario, the patient can sign the form without your being present, and you can sign the attestation portion later as long as you sign it before the surgery is performed. If the patient has further questions when he/she signs the consent form, the physician should be available to answer them. In addition, if the patient's medical condition has changed since the original informed-consent discussion, a new discussion may be required.
Q. Skin biopsy and punch biopsy are simple, low-risk procedures. Is it necessary to obtain informed consent for them?
A. As a physician,
you should ask yourself: Does the average layperson know about the risks,
benefits and alternatives to these procedures? If not, informed consent
should be obtained. Also, you can refer to the medical staff bylaws for
SHC and LPCH, as these bylaws specifically require informed consent for
certain procedures. The bylaws can be accessed at http://www.stanfordhospital.com/forPhysiciansOthers/
physicians/MedicalStaffServices/
Q. Can abbreviations be used on the consent form for common words (such as L and R for left and right) or procedures (such as CABG for coronary artery bypass graft)?
A. No. To avoid any possibility of error, all words must be spelled out completely.
Q. Will the consent form be available in other languages?
A. Yes - it will be available in Spanish, Mandarin, Vietnamese and Russian.
Q. Does the patient need to consent to have medical-equipment reps in the OR?
A. Yes. The physician should tell the patient that reps will be present and should document this discussion in the patient's medical record.
Q. How long is the informed consent valid?
A. Informed consent has continuing force and effect until (1) the patient revokes it, or (2) the patient's condition changes materially such that either the scope of the procedure or the risks change.
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Physicians with additional questions about the revised informed-consent policy can contact Connie Taylor, SHC's patient care policy and procedures coordinator, at connie.taylor@medcenter.stanford.edu or (650) 723-8301.
