INFORMED CONSENT

It’s really strange.  We spend more than half our lives planning and saving for retirement, then we retire and, in my case, wish we could go back to work.  I’ve seen this phenomenon before and mentally, was prepared for it. My plan was to never retire. I told my patients I was going to die in the office.

Someone said, “Man plans, God laughs.” God must be laughing!  Two nights ago, I got a real treat. No, not that!  What I got was a chance to see my patients in my old office for an entire night, in my dreams!  I was back in my element and happy.  Aside from being the first full night of sleep I’ve had in many years, it was a great trip down memory lane. 

One of the patients I saw took me back in time to the earliest days of my practice and one of my best lessons in practicing the art of medicine.  The lesson is particularly important as it pertains to what is happening in our country today. It has to do with the concept of informed consent.

Everything I did as a physician carried risk.  Every test I ran had the risk of being falsely negative or falsely positive.  Every time I drew blood, I ran the risk of injuring a nerve.  Every medication I prescribed came with risk of side effects.  When the risk was large, no matter how rare, it was my job to give my patient a thorough “informed consent.” 

In this particular case, my patient wanted a medication for a cosmetic problem.  The medication was thought to be somewhat effective for the patient’s condition but there were seven known cases of liver failure in the world literature.  If you asked me, one case was too many, but my patient insisted that seven cases in all the world literature were odds she was willing to take.

Well, I gave textbook perfect, informed consent.  I even had the spouse read the warnings and quizzed my patient and my patient’s spouse about their expectations and their understanding of the risk of taking it. My patient also consented to a monthly liver test just to be safe.  My patient became patient number eight.  My patient’s liver not only failed, it self-destructed.  Two liver transplants later and things stabilized.

The lawsuit came shortly afterwards.  I had done such a good job of giving informed consent and documenting it, that the suit was dismissed.  I actually wish my patient and their family had won. They needed the money and their lives were certainly ruined.  What I now know is true “informed consent” is a great idea. It’s also a fallacy!  My patient could not possibly have envisioned the shock and awe caused by the total destruction of their liver.  The patient and their spouse could not fathom being number 8 in the world.

Flash forward to today:  Those people who are taking hydroxychloroquine prophylactically cannot possibly imagine what life is going to be like after their heart is injured.  Parents who send their kids to school or Pom Pom practice cannot possibly understand what having a child dying alone in the ICU is going to do to their family.  Generation X and Millennials who ignore social distancing cannot possibly believe that a viral infection in the year 2020 will give them organ failure in the year 2030.

Consider document to be your informed consent!  I know you will scoff at it, discounting it as simple paranoia. I know that some of you will play the odds and continue life as usual.  Just remember that you’re betting with your life.

Here’s your music for the day.