What are the expectations for informed consent? So it's another normal day of unexpected findingss. I show up to evaluate my patient and there it is. Informed consent for the administration of gentamicin. Gentamicin is an antibiotic in the class of aminoglycosides. It is older than old. But it works great in certain circumstances.
But it comes with several potentially complicating side effects. Specifically, nephrotoxicity and neurotoxicity. Of course, I wouldn't want either one. But I wouldn't want a lot of side effects from a lot of medications.
I was blown away that a signed informed consent form was in the chart. So I called up the doc who asked that it be completed and asked them.
"Since when did we start filling out informed consent forms for gentamicin? Did you get sued or something?"
The answer was even more intriguing. Nope. No lawsuits, yet. However, it was at the recommendation of the risk management/malpractice carrier that anytime this drug is used, informed consent be obtained. There have apparently been lawsuits by other parties for side effects from this medication.
I sit here in amazement. Wondering what this means for internists every where. Will we have to have signed informed consent for every possible medication we prescribe?
Statins can cause severe rhabdomyolysis. Should we be required to have signed consent? Coumadin dosing can cause bleeding and necrosis. Should we be required to have signed consent? ACE inhibitors and diuretics can cause renal failure. Should be we required to have signed consent? How about Levaquin which can cause tendon rupture and increase the risk of clostridium associated colitis. Informed consent required?
How about putting in a peripheral IV. Informed consent? Perhaps informed consent before CT scan radiation exposure are done for the risk of radiation associated cancers and renal failure. Informed consent?
When does the ability to practice medicine efficiently and effectively get trumped by informed consent for possible complications of therapy. Where is that cut off? If I was required to sit down and discuss informed consent for every possible medication prescribed, every possible therapy I order. Every possible intervention performed, even free medical care would grind to a halt. And all parties would suffer immensely. Especially the patients.
Just one more reason why American health care is so inefficiently delivered.
Hault
ReplyDeleteHault\, a. [OF. hault, F. haut. See Haughty.] Lofty; haughty. [Obs.]
Through support of countenance proud and hault.
Maybe you meant grind to a halt?
My rheumatologist actually does hand out a list of the adverse effects with each med and does have me sign a consent--or rather, his nurse does.
ReplyDeleteWith hospital medicine? Not always possible. I'd rather someone inject me with pitocin and methergine if they think I'm bleeding excessively than have a conversation about it. But I think it's not a bad idea to let a conscious/aware patient know what drugs they're getting. (I.e., I'm not allergic to morphine and thus don't list it as a problem, but I'll start throwing up and would rather have ice packs and less pain med; zofran works while fentanyl for some reason doesn't, etc.) I've learned to be fast on the draw and ask quickly.
That's phenergan, not fentanyl. Not sure where my brain is today.
ReplyDeleteI think there should be release forms for the involuntary breathing of second and third hand smoke. Seems much more harmful than these side effects.
ReplyDeleteNow, there must be some clever lawyer that can figure out a way to sue in these circumstances so that such a release form would be needed.
Why not for Vanco? Not much different than gent. Imagine the hassle if we had to do this chaa for every patient with possible Staph
ReplyDeleteI'd assume when people get vanco there's not much choice, but they prob. should know the consequences.
ReplyDeleteI've always wondered why you have a separate consent form for anesthesia? Wouldn't you want to be asleep while surgeons monkey around with your vital organs? Mr. Cranky explained the whole thing to me once (he passes gas for a living) but I don;t exactly remember... must have been the sevoflurane fumes coming from his scrubs...
ReplyDelete(If I'm sounding silly it's because of all the flexeril)
Taking the time for a written consent when time is of the essence should itself require written consent.
ReplyDeleteAs I type this, I'm hooked up via PICC line to some daptomycin. Prior to this stuff, it was 12 weeks of vancomycin... My CPK was elevated *before* we started on Wednesday night. As an inpatient, I received several deliberate speeches about promptly reporting increases in muscle/joint pain (so I am sure something equivalent to "pt informed of risk" was charted); When I checked in at the I.D. infusion center, they presented a thick book of consents to sign. If this is all CYA medicine, I'm sorry to know that. I appreciate the **information**, especially as it can be tailored to my situation -- saves me the trouble of looking schtuff up and, being a non-medico, misunderstanding the pertinent details, or over-reacting, both things that tend to make people non-compliant. It's not a waste of my time...
ReplyDelete