1. Informed Consent it ain't no event

2. Dr Smith Goes Home.. Madlibs style (or so she thinks) Dr Smith is a _________ who is scheduled to do a ______ procedure tomorrow morning on Mr SquarePants. She met with him in the office a few weeks ago to discuss the _______ procedure, and he agreed with her that this seems to be the right thing to do. So as Dr Smith hops in her Lexus on the way to Little Timmy Smith's _____ practice... Her brand new _____ phone starts to play the theme from _______

3. What's a soccer mom to do? When we left our hero - she was answering the phone. Let's listen in: "Dr Smith?" "Yes?" "This is Nurse ____ I'm so sorry to call, but Mr SquarePants is here for pre-admission before his _____ tomorrow." "Yes - I know - the Intern, Dr _____ called me and we went over the admitting orders. His procedure is in OR 32 at 0645 tomorrow" "Well, we have a problem... you see... the consent form is not in his chart... "

4. THE CONSENT FORM IS NOT IN THE CHART Oh No - call Mr Bill!

5. But there must be options - no? 1.Have Nurse ____ get Mr Squarepants to sign the form now. 2.Call Dr _____ the Intern - he'll have Mr Squarepants sign the form 3.Cancel the procedure and send him back home 4.Call _____ the office manager and have him fax the office note from 2 weeks ago - which documents the discussion. 5.Get him to sign the form in the morning before the procedure Dr Smith has some choices. If YOU pick the right choice - you are a rare bird.

6. Informed consent is not 1.An event that happens when a patient signes a form 2.A transitive verb (" go consent Mr Squarepants") 3.A task to be delegated interns, medical students, or forest rangers 4.Required only for "procedures" 5.A boring subject - much less important than the Krebs Cycle, inner ear anatomy, or mitosis 6.Something you will learn about later - when you're closer to the front lines 7.Something that is fun to discuss at parties

7. When I was a student... There was one of those sit-in-the-front-row overachievers named ____ who started surgery with me one hot August morning. Our first rotation. He swaggered in to surgery clinic like George Clooney on "ER" o I slithered in - scared and fearful - wondering how anyone would trust me to help care for them He introduced himself as "Dr ____" and informed his new patients that he would be helping to care for them today. o I meekly introduced myself and offered everyone the option of dismissing me in favor of a resident or attending.

8. What Does this Have to Do with........ So by lunchtime... my "friend" has been asked to leave the room by three of the first four patients he ever meets...... and I'm starting to think this "patient care" thing might not be so intimidating as I had feared. They all seem to really LIKE me.. and somehow think that I'll be able to help take care of them.... and _______ asks me what I'm saying to them when I go into the rooms - since he's not thinking they understand how F&%$% smart he is. What's wrong with these stupid patients?

9. I think I see where you're going now.. What did my patients get? What didn't _____'s patients get? A CHOICE

10. Shared Decisions When patients and providers make decisions together - it's called informed consent. This means that the patient understands the (here come the only three words you need to memorize today).... o RISKS o ALTERNATIVES o BENEFITS Did the 3rd year student's patients understand this when he misrepresented himself as a physician? When he imposed himself on them? NO Did my patients understand this ? Yes!

11. Who are you? "I'm a 3rd year medical student. I'm here to learn, but I help Dr ____ as well." A 3rd year student involved in patient care involves some risks. What are they? Can you express them to patients? What are the alternatives? What are the benefits?

12. Informed Consent? Should all patients be offered an opportunity to make a decision about your involvement in their care? Do patients need to sign a form every time they share a decision with a provider? o blood test o student involvement - take social history o rectal exam o rectal exam by medical student o take medication o CT scan o chicken cross the road

13. Shared Decisions So informed consent isn't about signing a form - it's about having a relationship, having an open, engaging, respectful discussion. Questions are encouraged: "What other questions do you have?" Rather than discouraged: "Do you have any questions?" (muttered while reaching for the door).."ok then.. I'll be going... "

14. .. and who can have this discussion? Dr Smith has to have the conversation with Mr SquarePants - not the nurse, or the intern.. since they aren't the ones DOING the thing he has agreed to.. And having the patient sign a form while rolling in the OR is silly - and may be seen as having him sign under duress - or even under sedation. And the Hospital CEO (not to mention Mr SquarePants) will be angry if you cancel the procedure... So what's the right answer?

15. Since Informed Consent is not an event It's a process. Dr Smith and Mr SquarePants had a conversation that was well documented in the office record. While the hospital policy requires a paper form signed by the patient - this form is only meant to document the process. The form is not informed consent - and in the absence of the form - documentation of the process is preferable to a piece of paper that documents nothing at all. Final Answer..?

16. Remember this? 1.Have Nurse ____ get Mr Squarepants to sign the form now. 2.Call Dr _____ the Intern - he'll have Mr Squarepants sign the form 3.Cancel the procedure and send him back home 4.Call _____ the office manager and have him fax the office note from 2 weeks ago - which documents the discussion. 5.Get him to sign the form in the morning before the procedure Too bad you got it wrong. Answers to other questions: She's a urologist. Prostatecomy Field Hockey Blackberry Curve 8830 Love Story Ratchett ScutMonkey Marge JimBob