Parlez vous “consent”

It is a standard practice in medicine to request a patient’s consent before a procedure. During my surgical years, you actually could not touch a patient in the operating room until the patient had signed a consent form specifically related to the operation about to be performed. As draconian as this rule was, the bitter truth was that few patients truly understood the nature of their disease, the details of the procedure/operation they were about to undergo, and the possible negative outcomes from the surgery. In courtroom exchanges during malpractice suits, consent forms are often nullified on the principle that the patient had no knowledge of the details of the procedure/operation they underwent. In extreme ludicrous situations, the patient did not speak, read or write the language that the consent form was written in. Despite all of this, the presence of a consent form signed by the patient in the patient’s chart is considered a basic of medical documentation.

When physicians are challenged as to their patients’ poor understanding of their disease and treatments, responses will vary from “I did explain things” to “I explained as much as I could within my allotted five minutes of time”. The second excuse relates to the constant complaint of many physicians that the present system of remuneration makes it impossible for them to spend any significant time with the patient, even when the patient is about to undergo a life critical procedure. As ridiculous as this sounds, many physicians consider it to be a legitimate excuse. There is no point arguing with most physicians on this issue. I am interested in a simple and practical solution.

Most patients who are faced with a new medical condition, will run to the ultimate source of all knowledge: Google. If the patient is told that they have “lung cancer”, that patient will be searching on lung cancer before leaving the doctor’s office. With luck, the patient will quickly find a full explanation in simple enough language, in order to become sufficiently self educated to make reasonable decisions. When this patient is unfortunately faced with a complication or a very rare disease, it can become almost impossible to find the necessary information, even online. And once again, even when paying privately, patients will often not get the time they need from their doctors.

My solutions always resort to technology, and I do not deny this. Anything that a human feels is trivial or conversely too complicated to perform, a computer can often do very well. The whole issue of informing patients is a classic example where computers can be excellent sources of information. Imagine a world level project whose focus is to create 10 minute videos that explain any one of thousands of different medical entities. One video might discuss the cellular basis of cancer. Another will talk about how different chemicals in the blood affect our immune responses. Another could talk about potential complications from chemotherapy and how to deal with them. Imagine a worldwide competition where physicians and other individuals could submit such videos that would be voted on, via something as basic and universal as YouTube. Over time, this library of knowledge would grow to such a point that most people could find the information they need even in their own language.

Often times, physicians will state that such informational sites are problematic because they may be incorrect or be edited by someone with insufficient knowledge. This is one of the classic arguments against any type of wiki, whether related to medicine or not. Formal studies have been done to assess the accuracy of wiki websites, and generally speaking, they are found to be amazingly on point. Despite all of the negative forces in this world, people seem to have developed a unique level of respect for having one source of truth. Often, wiki sites are excellent sources of information even for very complicated types of medical issues. The purpose of such a video repository would by no means be to replace other sources of information, but provide a calm voice that can distinctly and correctly inform the patient.

Let’s now imagine that a patient is asked or even required to read up on or watch approved video material on their specific disease, before undergoing a medical procedure related to that disease. Doctors are often complaining about the fact that patients are improperly informed and end up acting “stupidly” or asking far too many unnecessary or inappropriate questions. By formalizing online information to be the “go to” source for patients, doctors could be relieved of a tremendous amount of stress. Needless to say, a properly informed patient is almost always a more successful patient.

The age of computers is ultimately meant to be the age of knowledge. All of the tools necessary for creating such knowledge are available these days, most often for free. A physician dressed nicely in front of a WebCam is all that is necessary to create an informative video that will be seen by a countless number of patients. Such a video could allay the fears of so many people and truly help them work through their medical condition far better.

Ultimately, it would probably be a relatively simple project to get this going. A major organization such as the AMA could spearhead such a project. Or, perhaps a European group could take ultimate responsibility for this. The point is that a central respected body should own this and commit to making it happen. The individual investments in time by any one of the video makers would likely be small. But the sum total of hundreds to thousands of professionals contributing a relatively small amount of time, would be a unique and critically important medical resource.

Sometimes, people will still ask how one person can make a difference. Contributing to the global body of knowledge is definitely a way for every individual to leave their mark while helping others.

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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