Informed Consents Are Often Skipped

I value those behind-the-scenes programs on TV, especially when they warn you of dangers that you may never know. Here is a little behind-the-scenes story that you will really want to read because it might involve you! One of my chief interests in making sure patients are not only treated properly but that all the safeguards and protections are observed.

Unfortunately, we have cultivated a health system that values expediency and cost-cutting over doing the job right and helping the patient.  I’ve seen some pretty egregious things done — especially for Medicare and MediCal patients.  The feeling seems to be that if people are not paying for their own care, they can’t be choosy about how they are treated. One of the legally-required steps that almost nobody in the public health sector (private pay or government pay) seems to observe is the informed consent. You have a right to know everything someone is going to do to you, everything you are given to ingest and everything that could possibly happen as a result. But that means paperwork and tedious explanations and sometimes complicated things to be explained — so it goes by the wayside. I kid you not, I’ve had to pinch myself to make sure I’m not dreaming. And the sad part is that when these things are reported, they are waved-away.  I’m often criticized for everything from being a “Polyanna” to being obsessive-compulsive to the worst thing of all — “Not being a team player.”

Yes, there are illegal things happening every day in every location and by some of the most highly-regarded people in the field. The informed consent is probably the most common oversight.  A doctor is required to secure written permission from a patient for each and every prescription given, for each and every procedure performed and for many other things, too. In a mental health clinic, I often hear that “these people” can’t understand what you are telling them, and that “these people” never sue (especially the “charity” patients). I heard it in France and I hear it in the USA. A recent example is typical — I’ve heard it hundreds of time.

I asked the person nominally in charge of me for informed consent forms.  The patient had already been on the medicines but had never signed one, and if we got sued, it must be in the patient chart.  I also asked him for the printed material we are required to give the patient regarding dosage, side effects, etc. His response was, “Just write a pack of lies into the computer.  That is what we are supposed to do.  Don’t worry — the patients like you.  And when they like you enough, they won’t sue you anyway.”

Although that may be true, it is illegal and unethical.  And if a patient DID sue, the clinic would throw me under the bus and claim I had willfully neglected to follow sacred and holy clinical policies — so I was solely to blame. It happens every day, and worse things happen too.  I feel helpless and upset every time.