Thinking about the attending physician that once told me I was taking too long on informed consent with patients. "It's good to be thorough, but sometimes you just need to get the form signed and go."
Miss me with that for a million years.
#MedTwitter #MedEd
Miss me with that for a million years.
#MedTwitter #MedEd
2/ A robust informed consent process prior to a treatment or procedure is not a "stretch goal" if we have enough time. It's not even the highest ideal of patient autonomy; it's the barest essential, the last line of defense that keeps medical care from becoming medical violence.
3/ In ideal patient care, everything is informed consent; just with other things tacked on to it. The goal of an office visit is to listen well, diagnose, explain, and reach a shared plan; it's just informed consent with a differential diagnosis and branching treatment paths.
4/ Surgical care is informed consent with (or without) an operation; the informing your patient and them consenting to their care- choosing their care and being in charge of it- isn't the one form, it's the entire therapeutic relationship.
5/ Maybe emergency medicine is the hardest in some ways because patients so often can't consent or state their goals. It's why we have multiple checks and balances (like out of hospital DNR's) and why we train doctors not to project their own wishes or worldview onto the patient.
6/ One of the biggest problems in medicine is that we've reduced patient autonomy- something sacrosanct that should guide everything we do- to a checklist item. "Get the form signed." And then we've made that item binary; all that matters is that it's done, now how it's done.
7/ So no, I'm not just going to "get the form signed and go." Instead, understanding my patient's goals, educating and empowering them, answering their questions, and centering their will instead of my own in their care will be the foundation of everything I do for my patients.
8/ Because that's what practicing Medicine IS. And if you can't seem to make the time for it, you are practicing something altogether different.
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