Your doctor says you should do A, but you’re not so sure. He says “it’s what I would do” and leaves it at that. You feel a little lost and confused. What does the doctor chart?
Informed consent given.
But was it?
What is Informed Consent?
Informed consent (in a medical situation) is a doctor’s obligation when giving a recommendation. It involves a few parts:
- Explain the procedure. Tell you exactly what will happen and how it will go.
- Explain the risks of the procedure. And, when done correctly this will often end with “you could die.” That certainly doesn’t mean you WILL die, it just means that one person out of a ba-zillion people died, and it is his job to tell you that happened.
- Explain the benefits of the procedure. Why are they recommending it for you?
- The doctor mentions alternatives to the procedure he recommends and goes over those risks/benefits as well (although not as in depth).
- You have the opportunity to have all you questions answered.
Now, very rarely will I see this whole informed consent given.
But in almost all medical situations it SHOULD happen. Let’s give a few examples:
A doctor is recommending a woman should have an elective C-section because her baby is “too big”
- The doctor would explain the c-section and how it all works. How long you’ll be in the hospital and what you’ll face after the procedure.
- Tell her the risks of the procedure, anesthesia effects (although those are also told by the anesthesiologist), risks of infection, risks of bleeding — and of course, this ends in “you could die.”
- Tell her why he’s recommending it. In this case, the benefit would be to the health of the mom and the baby if the baby can’t fit through the birth canal. Also, it would save her wasted hours of labor and the possible pain of labor before deciding to do a c-section because of the baby not fitting. He should also back it up with tests he’s done to let him reach this conclusion.
- The alternative to this would be trying labor. It might be long, and painful and might not work.
- You are then able to ask questions. Why do you think the baby is too big, in your experience have women ever sucessfully had a vaginal delivery when you felt the baby was too big? etc.
It is NOT informed consent when the doctor walks in the room and says. “You’ve been in labor too long and you need to have a c-section. You need to understand that your baby might die if you don’t do this. This strip looks horrible, your baby is obviously not doing well, I think we should do it now.” What was wrong with that situation?
- He didn’t explain how a c-section would work. Some doctors do go through how they go through layers of skin and get to the uterus. I really appreciate it when the doctor does all of that with the patient. He should certainly mention how long you’ll stay in the hospital afterwards.
- He mentioned no risks of the procedure. And, there are plenty for a c-section. YES, it is often the safest way to get a baby out, but it has a lot of risks involved with it.
- He did, sort of, say why he’s recommending it. Although, he should be more clear — something like, “Your baby’s heartbeat doesn’t look good. It looks like it’s getting tired out from labor. I think it might be healthier if we get it out now.”
- No alternatives were given. Obviously, the alternative might be to stop the induction for a bit; give the baby a brief time to recover. Or just waiting it out. Honestly, this is NOT always an option. If you have nurses swarming you, a quick informed consent might be necessary, but it is not often the case (even though doctors like to pretend that it is).
- She had no time to ask questions, or give input.
This same type of consent can be applied anywhere in the medical field, but since labor and delivery is my main field it should happen with:
- Tubal Ligation
- Hormones given in early pregnancy (or any drug given in pregnancy)
- Procedures, like a version, or a cerclage
As a mom it should happen in your other medical situations. Things like stitches, dental procedures, immunizations. All of that needs informed consent!
I also note that it doesn’t always happen well. BUT, good doctors do it. They are honest and they give you time to think about it and ask them questions. You can always ask “Do I have time to think about it?” Yes, sometimes, you don’t have time to think about it, but most often you do.
This is my biggest beef as a nurse. I do see patients pushed into things they don’t want and they haven’t been properly informed about. You have rights as a human, and one of the most basic is to make your own choices.
Hopefully this post about informed consent helped give you some ideas on what to ask your doctor and to stand a little more firmly on your own ground.
Never take the advice from Pulling Curls over the advice of your doctor.
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