“my doctor never told me that would happen!” a paent ... · pdf filea...
TRANSCRIPT
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“MyDoctorNeverToldMeTHATWouldHappen!”
APa:ent-CenteredApproachto
InformedConsent
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Real-WorldApplica:ons
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“DoctorKnowsBest”• Visually-significantptosis• Nocontraindica:onsforrepair
“You’retheDoctor.Whateveryouthinkisbest.”“IfIwereyour____whatwouldyourecommend?”
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Pa:entKnowsBeQer• Handoutliterature• Writedownsearchterms,websites• Talkwithotherpa:entsorfamilymembers• Returnwithfamilymember,advocate
• Mostpa:entsfollowouradvice:treadcarefully
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“LikeFather,LikeSon”• Dimytriis2monthsold• Developmentalcataracts• Dadhadthemtoo,Ukraine• “Idon’twantmysontogothroughsurgery”• “Thereareworsethingsinlife.”
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RightofRefusalandSurrogacy
• Extrac:onisinDimytri’sbestinterest• Pa:ent,consen:ngpartyarenotthesame
Towhomisthephysician’sduty?
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Strategies• Pa:enteduca:on,websites,founda:ons• Partnerwithanotherfamilymember• Engageanotherfamilywho’sbeenthere• Returnvisits• HospitaladvocacycommiQee• Legalinterven:on(lastresort)
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“NotinMyBackyard”• Pa:entneedscataractsurgery• Seenatlargeteachinghospital• Goodsecond-yearcase• “IwatchGrey’sAnatomy.Noresident’scu^ngonme.”
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Findings• 95%pa:entswantedtoknowrankoftrea:ngM.D.• 56%understoodAQendingvs.Fellowvs.Resident• 52%wouldsaynotobeingresident’s1stLP
– 36%wouldsaynotoevenresident’s10thLP
Thoseleastinformedaboutmedicalhierarchywereleastcomfortablewithresidentinvolvement
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StudentDoctor• Pa:enthasrighttoknowandchoosewhowilltreat• Manywillconsideritanhonor• Others,notsomuch• Limi:ngtraineeinvolvementatoddswithmissionofteachinghospital
• AQendingcanagreetopa:entchoiceorreferoutsideteachingins:tu:on
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“EyeoftheBeholder”• 44-year-oldKoreanhedgefundmanager• Treatmentfor“:red-looking”eyes• Nolidcrease• Motherwithsimilarappearance,corneasnearlyhiddenbyexcessiveskin
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• Seesprominentplas:csurgeon• Localcelebrityglossyphotos,“BestDoctor”magazinecovers,cherrywood,moodligh:ng
• Surgeonaffable,detailsR/B/Aofupperblepharoplasty,answersques:ons
• Pa:entleavesconfidentinsurgeonchoice
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• Unevenlulsurgery,standardlidcreaseincision,lidcreasereforma:onsutures
• POD#7,swollen,bruised,FBSbuto/wOK• POD#14,traceswelling,bruising• Frontdeskstaffcomplimentaryofnewappearance
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• Surgeonishappywithresults• “Nowyouhaveaniceplacetoputeyeshadow!”
• Pa:entbreaksdown• “Idon’tcareabouteyeshadow.Iwantedtogetridofmy:red-lookingeyes,notmyKorean-lookingeyes!”
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WhatWentWrong?Surgicaltechniquewithinstandardofcare
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WhatWould(Asian)Pa:entWanttoKnow?• It’sallaboutthecrease• Placement,effectofincision• Whatdoespa:entwant?• Preserveracial/culturaliden:ty,resonance
• Respectpersonal“blemishes”
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InformedConsentChecklist• Natureofprocedureexplained,inadvance• MaterialR,B,As• RisksofNOtreatment• Timetoaskques:ons• Abovedonebysurgeon• Formissigned• Copygiventopa:ent
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ForExtraCredit• Cogni:ve/mentalstatus• Sensory,language,literacyimpairment
• Interpreterprovidedifnecessary• Pa:ent“teachback”• Presenceofothersdocumented
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ForExtraCredit• Natureofrecoverydiscussed• Roleofassistants,reps,residents• Post-oproleofassistants,residents,otherproviders
• Physicianinexperience• FDAapprovalandofflabelstatus
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NobodyLikesSurprises
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YouCannotPreventLawsuit• ButyouCANmakeyourcasemoredefensible
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InformedConsent• PROCESS• pa:entautonomy• Riskassessment• Ra:onaldecisions
Founda:onforhealthyphysician-pa:ent
rela:onship