Introduction to Informed Consent

00:01 So in this lecture, we're going to be talking about informed consent.

00:04 A common everyday practice when we're taking care of patients.

00:08 Now, people will generally think about informed consent when you're thinking about a surgeon bringing a patient to the operating room.

00:14 Or procedural is like an interventional radiologist or gastroenterologist taking the patient for procedure.

00:21 But it happens every day when we're prescribing medications to a patient.

00:24 So, I'm in internal medicine.

00:27 And common practice for me is in taking care of patients with hypertension.

00:32 So if I've diagnosed somebody with hypertension, I need to prescribe an antihypertensive medication.

00:37 I'm going to need to go through with them this informed consent process.

00:42 So I need to explain the rationale for why I think it's important to treat their hypertension.

00:46 To hopefully prevent them having heart attacks or strokes in the future.

00:51 Understand the natural history of hypertension, and what it can do to the body.

00:56 Why I'm proposing a medication for them? I might also recommend lifestyle modification, restricting their sodium intake, getting more physically active, stopping smoking.

01:08 Various things that might be needed to help manage their hypertension.

01:13 But if I think they need medication, then I need to go through, What are the benefits of taking medication? Gets their blood pressure under better control.

01:20 What are the potential risks of the medication I'm prescribing? If I'm going to prescribe an ACE inhibitor, I might need to tell them that I have to monitor their kidney function or their potassium level.

01:32 15% of people might have a cough associated with use of an ACE inhibitor.

01:37 So I might need to forewarn the patient that they might experience tickle in the throat and get a cough.

01:41 They should let me know about that if it's becomes a nuisance.

01:45 If it's a 35-year-old woman that is potentially wanting to get pregnant one day, I might need to factor in that.

01:54 If she wants to become pregnant, there might be estrogenic effects prenatally to a fetus from use of an ACE inhibitor.

02:02 So that would be an instance where maybe that's right, not the right medication choice for her.

02:06 So I'd need to walk through.

02:09 Are there other options? Are there other alternative medications that we might choose that would be best suited for that particular patient? So all of these sort of have to be considered in the everyday practice of medicine.

02:21 So this lecture is going to be talking about the informed consent process.

02:28 So the first point to make is, while we commonly refer to it as informed consent.

02:33 It's really informed decision-making.

02:35 So thinking back to other lectures where we talked about respect for autonomy.

02:41 There's also the option that the patient could say, "No".

02:44 Then it's a refusal of making that treatment decision whatever we might be recommending.

02:51 So they have the right to either consent or to refuse the proposed treatment. So it's really their decision.

03:00 So why is this important? Well, first of all, I as a physician or a doctor, the root of the term doctor is Docere, which means to teach.

03:12 So I'd say one of the core elements of my role as a physician, is to teach my patient about their health, about their condition, what's going on in their body.

03:24 If I'm proposing a treatment, I have to teach them about that treatment.

03:27 So it goes along with being a teacher to the patient.

03:33 The other reason that it's important is just communication.

03:36 So the exchange of information starts at the very first time I meet with the patient.

03:42 So that initial encounter where they're describing their symptoms, and I'm exploring it, trying to understand what they've been going through.

03:51 Trying to come up with a diagnosis, that back and forth exchange of information is really a means of getting eventually to an informed consent of, I make an assessment of what's going on to them.

04:02 And then I'm going to recommend a treatment.

04:04 So, ongoing communication with the patient is critical.

04:09 The reason to do informed consent is also to show respect for the patient.

04:12 So, I respect them enough to want to give them the information so that they can be self determining that they can make their own decisions.

04:21 And my means of explanation is really a sign of respect for them.

04:27 And that I value their input.

04:30 It's also important that the patient feels that they can trust us.

04:35 So if I'm hiding information or not disclosing things that are going to be relevant to their health or to their health care, then, there may be issues of distrust.

04:46 So this is really a means of building trust with the patient and being forthcoming, explaining things hopefully in understandable terms, and that's a means of building trust.

04:56 That they can then say, "Yes, I want to work with this clinician to take care of me." And that also then not only trust but builds a relationship.

05:05 So the back and forth exchange of information, that communication that's going on is a means of building that clinician patient relationship.

05:15 Which is then going to see you through into the future, as you assess how the treatment is working.

05:21 Whether you need to make modifications, and so on.