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Open Wide and Say Uh-oh

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I had been delaying this visit for awhile now in hope that whatever was growing under my tongue would heal itself.'  I'd already exhausted visits with a dentist and a physician assistant, but an oral surgeon just sounded so intense for what I presumed was not that big of a deal.

As I offered a courteous hello and my name, the receptionist kindly responded with a 'how are you?' as she passed a clipboard loaded with paperwork over the counter.

The usual suspects were there, including registration and insurance forms and a copy of the Health Insurance Portability and Accountability Act (HIPAA).'  But, the very last paper was a curveball: a consent form for any procedures performed.'  How odd!'  I just had walked into the office for the first time and I'm already giving my permission for the surgeon to perform whatever he deemed necessary.

I asked the receptionist if I could hold onto that form, explaining that I didn't even know what I was consenting to.'  I wanted to spend more time than it takes to sign a credit card receipt to determine what next steps to take for my medical condition.

Whatever happened to consent as more of a process rather than sitting in a waiting room mindlessly signing another form buried in a stack of papers?'  I cringed at the idea of people completing this form before ever seeing a doctor or a nurse, possibly dismissing a detailed opportunity for valuable questions to be asked, treatment decisions to be negotiated, and medical explanations to be provided.

I envision the consent process through my rose-colored glasses as how it was intended to be integrated into health care as stated by the American Medical Association ''as a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.''  My interaction with the front desk far from resembled this: no doctor, no communication and no specific interventions.

I did not have a bad encounter with the oral surgeon, but as I expected, he was interested in surgery, while I was interested in something less invasive than removing a salivary gland from my mouth forever for a blocked salivary duct.'  I settled for an antibiotic and watchful waiting.'  Two weeks later, my mouth was cleared of the growing mass under my tongue, but I was left with a bad aftertaste of that office's shoddy process of consent.

What are your informed consent stories?

More Blog Posts by Sarah Jorgenson

author bio

Sarah Jorgenson, MA, MS, is currently a medical student in Chicago. Previously, she served as a communications and research associate for the Center for Advancing Health (CFAH) and as a contributing writer for its Health Behavior News Service. She graduated with an MA in Bioethics, Humanities and Society from Michigan State University (MSU), where she worked as a research assistant for Dr. Margaret Holmes-Rovner with the Center for Ethics and Humanities in the Life Sciences. She served on the research team for CFAH's Snapshot of People's Engagement in Their Health Care, contributed to a Cochrane Review update, and participated in research on shared decision making for patients with coronary artery disease. She also worked as a receptionist at MSU's Child Health Care Clinic for two years and collaborated as part of the research team for its Patient Centered Medical Home. You can follow her on her blog and on Twitter via @SarahJorgenson.


Tags for this article:
Oral Health   Sarah Jorgenson   Communicate with your Doctors   Participate in your Treatment  


Comments on this post
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Dorothy Jeffress says
June 25, 2010 at 8:57 AM

Signing the informed consent form at the beginning of an appointment makes sense for dental professionals and staff. It doesn't preclude the kind of discussion you had with your oral surgeon, but does mean that your visit is not interrupted by the need to sit up and sign a form in the middle of it. And most people probably sign that form without a second thought.

Unfortunately my vast experience with consenting to various medical procedures have tended toward the casual performance of an administrative ritual on my part and the part of the professionals administering them. Stipulating as a quality standard (for example see : http://www.jointcommission.org/standards/ ) the presence of the signed form hasn't succeeded in getting any of us to take it seriously. What will?"

Jessie Gruman

Dorothy Jeffress says
June 25, 2010 at 8:58 AM

Note that the first comment was submitted by me on behalf of Jessie Gruman.

Wellâ?¦.I just think for most people â??surgeryâ??â?¦.implies a more invasive and complex treatment say than Rx or other therapiesâ?¦and worth having time to hear the physicianâ??s opinion, weigh all options and consider next stepsâ?¦.all of which seems to be precluded by signing a blanket consent form prior to an examination.

It may be an efficient way to expedite clinical operations but does fly in the face of the need for patients to make individual choices about treatmentâ?¦.with the opportunity to examine each situation on its own merits

The meta message from the physicianâ?¦.to meâ?¦is just put your care and treatment in my hands and I will make the best decisionsâ?¦donâ??t worry your sweet little head about anything. NO need to explain or discussâ?¦and in the hands of a surgeonâ?¦.wellâ?¦.safe to assume whenever possibleâ?¦.surgery comes out on top of watchful waiting or less costly/dramatic interventions.

Dorothy Jeffress