Informed Consent and Transparency

So much has been covered in the last three days at The Telluride Research Experience #TPSER9 that I hardly know where to begin…I have thoughts on communication, patient safety, interdisciplinary interactions, and transparency with my patients and coworkers…I think as I process through all of these I will create multiple posts. For now I would like to focus on transparency in care.

In thinking about informed consent and transparency in medical and nursing care, I wonder what that looks like on a daily level, particularly on the floor. Obviously there needs to be informed consent for major surgical procedures and tests. I feel most people understand that. But what about the daily things? Starting a new antibiotic, initiating an indwelling foley catheter, starting an IV…each of these have risks associated with them. The antibiotic could cause some GI upset or increase risk of C. diff., the catheter will increase chances of a UTI and could cause some trauma if not inserted properly. How often are these risks discussed and is active bilateral dialogue had between the patient and the healthcare provider (versus saying “we are doing this”)? Furthermore, how do we verbalize this as students?

Should we be telling a patient we have never inserted a foley catheter, an IV, had a successful venipuncture on the first try, or inserted an NG before? Shouldn’t the patient know the person doing this procedure has only done this on dummies or a model? Or is this a “part of being in an academic hospital” and “they should know that”? (Comments I have overheard many times.)

I for one remember learning in school to never say to a patient this was my first (or second) time doing something, and if they asked to not directly answer (I have, after all, started an IV on a mannequin arm multiple times.) Is this building trust though?

After some of the discussion over the last few days I now feel it is not. Isn’t withholding information synonymous to lying? What do you all think? Do you think this would affect patient care and build trust? And on the flip side, do you think this would affect the learning experience for nursing students and medical residents as we attempt to gain clinical experience?

Curious to hear what you all think.

The best advocate

By John Joseph, MS2 Wayne State School of Medicine

We completed the first day of the Telluride Patient Safety Summer Camp and I can say already that I am so glad I took the time to make the trip out. Telluride is a beautiful place and the enthusiasm and passion of the participants and leaders has reignited my interest. The lesson that stood out the most to me today was the video put together by Drs. Mayer and McDonald on the heartbreaking case of Lewis Blackman. His mother, Helen Haskell, fought tremendously for Lewis while he was in the hospital (and she continues to fight the system that killed him to this day) after a routine surgery. She trusted her instincts that something was wrong and repeatedly pushed for more senior physicians to examine Lewis, over and over and over. I was shocked that despite her insistence, that her requests were not honored. I was also horrified to think that if this type of cascade of errors can persist when the patient has a vocal advocate like Helen, what must happen to patients that are alone or do not have advocates that feel comfortable or able to question at all? How many children and adults have died because they did not have someone on their side? This hammered home the need for patient advocates and I look forward to learning more about their roles and implementation later in the week.

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