In the briefest terms, a physician is required to provide general information about a proposed diagnosis or treatment and more personalized information about how the treatment might reasonably affect the particular patient. Truly informed consent may also require disclosure of potential risks associated with not seeking treatment.
Full Answer
Should physicians deliver treatment against the patient’s wishes?
Should the physician deliver treatment against the patient’s wishes? Remarkably, there is little guidance for physicians, even though the situation arises frequently. To address this gap, Kenneth Prager, MD, and Jonah Rubin, MD'16
What kind of information can a doctor give a patient?
Under these circumstances, for example: A doctor may give information about a patient’s mobility limitations to a friend driving the patient home from the hospital. A hospital may discuss a patient’s payment options with her adult daughter.
Why is it important for a doctor to understand his patients'thoughts?
As a physician it is always helpful to appreciate your patient's ways of thinking about health and treatment and find some common ground where there can be agreement.
Should doctors involve patients in making treatment decisions?
Doctors are encouraged to involve patients in making treatment decisions, but this poses challenges for doctors Practical concerns include the extra time needed and the difficulties in eliciting patients' preferences, exacerbated by limited appropriate information to support patient involvement
What is dread disease insurance?
Dread disease coverage; Limited coverage policies, such as dread disease policies, only cover specific medical costs, geared to a particular illness, such as cancer, or a field, like prescription drug or dental care.
Does insurance cover a procedure?
Is not covered; An insurance company will pay the usual, reasonable, or customary amount for a given procedure based upon the average charge for that procedure.
Is hospice a curative setting?
A; In a cost-containment setting, daily needs and pain relief are provided for hospice patients, but curative measures are not.
When treatment over a patient's objection would be appropriate?
KP: A simple example of when treatment over a patient’s objection would be appropriate is if a psychotic patient who had a life-threatening, easily treatable infection was refusing antibiotics for irrational reasons. Treatment would save the patient’s life without posing significant risk to the patient.
What are the first few questions in a treatment plan?
The first few questions consider the imminence and severity of the harm expected to occur by doing nothing as well as the risks, benefits, and likelihood of a successful outcome with the proposed intervention. Other questions consider the psychosocial aspects of this decision—how will the patient feel about being coerced into treatment? What is the patient’s reason for refusing treatment? The last question concerns the logistics of treating over objection: Will the patient be able to comply with treatment, such as taking multiple medications on a daily basis or undergoing frequent kidney dialysis?
Is there anything out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients?
And there are fairly clear policies and laws concerning the ethics and legality of delivering psychiatric care to patients who refuse it. But there is nothing out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients who lack decisional capacity.
Can you force dialysis on a patient who resists?
As Dr. Rubin stated, one cannot force three times weekly dialysis sessions on a resistant patient even if it means that the patient will die without the treatment.
Why do doctors need to understand patients' preferences?
To improve the quality of care they provide , doctors should understand their patients' preferences. However, this raises many challenges for doctors. Practical concerns include time pressures and difficulties in eliciting preferences from patients who may be hesitant to make treatment decisions. These are compounded by a deficit of appropriate information to support patients' decisions. Doctors may not have the appropriate interpersonal skills, particularly for communicating risk. Medical uncertainty, deficiencies in individual doctors' knowledge, and the highly variable ability of patients to understand and remember clinical information mean that risk communication is often inadequate to support patients in making informed decisions.
Why do patients need to be given technical information that is clear and unbiased?
Patients must be given technical information that is clear and unbiased to ensure that their preferences are based on fact and not misconception.
Why is it important for health professionals to involve patients in treatment decisions?
Health professionals are increasingly encouraged to involve patients in treatment decisions, recognising patients as experts with a unique knowledge of their own health and their preferences for treatments, health states, and outcomes.1,2Increased patient involvement, a result of various sociopolitical changes,w1is an important part of quality improvement since it has been associated with improved health outcomes3w1-w9and enables doctors to be more accountable to the public.
What is the Foundation for Informed Medical Decision Making?
Foundation for Informed Medical Decision Making (www.fimdm.org/). US group that, as a result of concerns about variations in medical intervention rates, encourages patients to play a greater role in choosing treatments. Produces web based and video decision aids
What are the two components of treatment decisions?
Although some patients may not wish to make the final choice of treatment, many would prefer more information.w12-w14Deber suggested there may be two components of treatment decisions—problem solving (“identifying the one right answer”) and decision making (“selecting the most desired bundle of outcomes”) —and hypothesised that, whereas patients may prefer doctors to perform the problem solving component (which requires clinical expertise), patients would want to be involved in decision making.13This was supported in a survey of patients undergoing angiography.w15
What are practical concerns?
Practical concerns include the extra time needed and the difficulties in eliciting patients' preferences, exacerbated by limited appropriate information to support patient involvement
Is a shared decision acceptable for both patient and doctor?
In many cases a shared decision that is acceptable for both patient and doctor will arise from discussion, but sometimes this is more problematic.
How to assess a patient's condition?
Making certain that a patient understands his or her condition can be best assessed by open-ended inquiry, for example, “Can you tell me what your medical problem(s) consists of?” or “Why have you been brought to the hospital?” Avoid questions that elicit a yes or no reply, e.g., “Do you understand what your medical condition is?” since an affirmative reply does not clearly convey that the person comprehends the nature of the illness.
Why are psychiatrists asking for psychiatric consultation?
Requests for psychiatric consultation by primary care physicians to assess capacity to make treatment decisions have been increasing.11A retrospective chart review12of consultation requests made to psychiatrists in a municipal general hospital and a university-affiliated hospital found that as many as one fourth of all consultation requests were to assist with deciding issues of capacity. Earlier studies found lower rates of referral to psychiatric consultation services for capacity assessment, ranging from 3.3% to 15%.13–15The increase in consultation requests for capacity assessment suggests that physicians may be uncertain about, and perhaps overwhelmed by, the complexities encountered when addressing issues pertaining to medical decision making.
Why is incompetency considered labor intensive?
Because an adjudication of incompetency effectively denies an individual autonomy to make decisions, such court cases become labor intensive. An individual is presumed to be competent unless demonstrated to be otherwise. The standard of proof required for judicial finding of incompetency is that of “clear and convincing evidence.”6This standard of proof, based on evidence presented by licensed health care practitioners and others, is set at a standard between the high level of proof required for criminal convictions, i.e., “beyond a reasonable doubt,” and the lowest standard of “preponderance of the evidence.”7
What is the mental status test?
Often, psychiatrists will conduct a mental status examination, such as the Folstein Mini-Mental Status Examina tion,32the Short Portable Mental Status Question naire,33and the Cognitive Capacity Screening Examination,34to have a more formal measure of the patient's ability to manipulate information. Such tests measure cognitive abilities, but not decision-making capacity. Scores yielded by such instruments provide an indication of severity of dementia, but cannot yield a score for and lack sufficient sensitivity for decision-making capacity.35,36It is possible that an educationally disadvantaged person scoring poorly on the Mini-Mental Status Examination or alternative test can retain an ability to make treatment decisions, while a highly educated person adept at responding to the test's questions can fail to make prudent treatment decisions.37Dementia and cognitive deficits, e.g., mild mental retardation, may not necessarily preclude decision-making capacity.38
What are systemic lines of inquiry?
Systematic lines of inquiry can tap into risks and benefits, for example, “What can happen to you if you have the surgery?” “What is your understanding of the side effects of this particular medication?” or “The proposed test carries some risks; can you indicate what they are?” Frame questions assessing the benefits of the proposed interventions in a similar fashion and attend to the patient's understanding of probabilities of favorable or unfavorable outcomes.26Patients may well understand the reasons for the proposed procedure and how it is conducted, but may distort the likelihood of success or deny likely untoward or adverse consequences.
What is appreciation assessment?
The concept of appreciation is a rather individualized component of the capacity assessment. Assessment of the patient's ability to appreciate is not based upon the comparison of the patient's expressed wishes against the standard of what most reasonable persons would endorse in that situation. It does involve an appreciation of how the individual values each risk and benefit of the proposed treatment in question. Severe denial as a defense mechanism, delusions, or other psychotic processes can impair appreciation.30,31
What is capacity in medical terms?
Capacity refers to an assessment of the individual's psychological abilities to form rational decisions, specifically the individual's ability to understand, appreciate, and manipulate information and form rational decisions. The patient evaluated by a physician to lack capacity to make reasoned medical decisions is referred to as de facto incompetent, i.e., incompetent in fact, but not determined to be so by legal procedures. Such individuals cannot exercise the right to choose or refuse treatment, and they require another individual, a de facto surrogate, to make decisions on their behalf.
What is the proper notice to give to a patient who is actively treating for a condition?
For a patient who is actively treating for a condition, a physician must: give the patient proper notice that the physician is terminating the physician-patient relationship , and. give the patient sufficient time to find another physician before finally refusing to treat the patient any further.
What happened to the patient as a result of the physician's abandonment of the patient?
as a result of the physician's abandonment of the patient, the patient's condition was made worse
What Is a Physician-Patient Relationship?
A physician-patient relationship is the professional relationship that a doctor has with his/her patient. The relationship begins when the physician first diagnoses and treats the patient, or at least participates in the patient's diagnosis and treatment. The physician-patient relationship continues until either the physician or the patient terminate the relationship. The physician-patient relationship is both an ethical relationship governed by the state medical boards and a legal relationship defined by the courts or by state law.
What happens if a physician terminates a patient relationship?
However, if the physician never formally terminated the physician-patient relationship, then, depending on the circumstances, the patient may have a reasonable expectation that the physician will continue to treat the patient.
What does it mean when a physician abandons a patient?
Once a patient-physician relationship has begun, a physician is said to "abandon" a patient who still needs medical attention when the physician refuses to continue treating the patient (i.e., severs the physician-patient relationship) without giving the patient proper notice and an adequate amount of time to find another physician who can take over the patient's care. Medical abandonment can form the basis of a medical malpractice case. Read on to learn more.
How to give a patient notice of termination?
Giving proper notice to a patient usually includes telling the patient, either on the phone or face to face, that the physician is terminating the physician-patient relationship and writing the patient a letter confirming the termination. The letter should be sent by certified mail, return receipt requested. The physician should not just say to the patient, "You're fired. I don't want to see you anymore." The physician should tell the patient the reasons why he/she is terminating the relationship.
How long does a patient go without medical treatment?
Let's say that a physician stops seeing a patient without giving proper notice, and, as a result, the patient goes without medical treatment for three months. As a result of this three month gap in treatment, the patient is left with a permanent disability.
What do patients want?
Patients want nonjudgmental, compassionate, honest advice about what they are doing. Do not instantly dismiss what they share as useless. Do not say to throw it all in the garbage. Patience is a virtue. Patients are trying to be autonomous and do things for themselves (self-care). At least we can acknowledge the importance of patients' wishing to take responsibility for their own health and support their autonomy.
Why is it important to appreciate your patient's ways of thinking about health and treatment?
As a physician it is always helpful to appreciate your patient's ways of thinking about health and treatment and find some common ground where there can be agreement. Rather than attacking a patient's beliefs, it is more helpful to understand where they are coming from and how they developed these misunderstandings and sometimes mistrust of modern medicine. I have learned a lot about alternatives by just listening to my patients' experiences.
Why are physicians concerned about complementary medicine?
Physicians are also concerned patients are getting ripped off financially and are worried about the potential of interaction between natural health products and herbs and the drugs and treatment we are giving.
What does it mean when a doctor says "it's either my way or the highway"?
They feel that unless a patient follows their advice then the patient should find another doctor. While this is perfectly understandable it feels more patient-centered and helpful if we are willing to negotiate and compromise.
Why do people with AIDS seek alternative treatment?
Patients with AIDS, cancer, and chronic mental-health illness often seek alternative treatments and practitioners because their conditions are not always adequately helped by conventional medicine.
Why do patients and doctors work together?
When patients and doctors work together as a team, health outcomes are enhanced. The future of healthcare will hopefully be more collaborative. Patients will be better taken care of when all the healthcare practitioners who are providing treatment communicate more effectively with each other.
What is the first and most important point in a medical visit?
The first and the most important point is asking patients if they are using herbs or natural health products or visiting an alternative practitioner. This should be standard as part of the history for any medical visit.
What does a doctor instruct a patient's roommate about?
A doctor may instruct a patient’s roommate about proper medicine dosage when she comes to pick up her friend from the hospital.
Who can give information about a patient's mobility limitations?
A doctor may give information about a patient’s mobility limitations to a friend driving the patient home from the hospital.
What does a surgeon do when a patient has a heart attack?
A surgeon may, if consistent with such professional judgment, inform a patient’s spouse, who accompanied her husband to the emergency room, that the patient has suffered a heart attack and provide periodic updates on the patient’s progress and prognosis.
When does a covered entity share information with a patient?
Even when the patient is not present or it is impracticable because of emergency circumstances or the patient’s incapacity for the covered entity to ask the patient about discussing her care or payment with a family member or other person, a covered entity may share this information with the person when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510 (b). Thus, for example:
Can a doctor discuss an incapacitated patient's condition with a family member?
A doctor may , if consistent with such professional judgment, discuss an incapacitated patient’s condition with a family member over the phone.
What tests do doctors do?
Sometimes, doctors need to do blood tests, X-rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap tests, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done regularly to check for hidden medical problems.
How to deal with medical conditions?
If you understand your medical condition, you can help make better decisions about treatment. If you know what to expect, it may be easier for you to deal with the condition. Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last.
What to ask a doctor about a generic?
Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. You can ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”
What to ask before a medical test?
Before having a medical test, ask your doctor to explain why it is important, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results ...
How to write down how often you should take a medication?
Understand your medications. Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it. Make notes about any other special instructions.
What to do if you don't ask a doctor?
Asking questions is key to good communication with your doctor. If you don't ask questions, he or she may assume you already know the answer or that you don't want more information. Don't wait for the doctor to raise a specific question or subject; he or she may not know it's important to you. Be proactive.
What will we know after a blood test?
What will we know after the test? When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.
Risks
- Many patients may have a limited understanding of medicine, so it is difficult, if not impossible, for a physician to confirm that a patient has given adequately informed consent. Hence, it is almost self-evident that adherence to the doctrine of informed consent requires a physician to di…
Origin
- The legal doctrine of informed consent can be traced back to the post-World War II Nuremburg Code, a set of guidelines drafted to ensure that unethical medical experiments were no longer carried out in the name of science. The doctrine is founded on the general principle that a person of the age of majority and sound mind has a legal right to determine what may be done to his or …
Issues
- Traditionally, courts held that a physicians duty to disclose information to the patient depended upon community disclosure standardswhether the majority of physicians within a particular community would customarily make such a disclosure [2]. More recently they have acknowledged problems with the community disclosure standard, chiefly that it creates an incentive for physici…
Example
- In Canterbury, a young man was advised by his physician to undergo a laminectomy in an effort to alleviate back pain. The physician, aware that 1 percent of laminectomies resulted in paralysis, did not advise the patient of the risk because he believed this might cause the patient to reject the useful treatment. Following the procedure, the patient fell from his hospital bed and was paralyz…
Facts
- The patient sued, alleging that the physician failed to inform him of the risks associated with the procedure. The court held that the standard measuring [physician] performanceis conduct which is reasonable under the circumstances [3]. In other words, the court held that, instead of adhering to the community disclosure standard, physicians are now required to disclose information if it i…
Significance
- In Canterbury, the decision outlined key pieces of information that a physician must disclose: In two informed consent cases following Canterbury, physicians have also been required to disclose (1) personal or economic interests that may influence their judgment (Gates v. Jenson) [6] and (2) all diagnostic tests that may rule out a possible condition (Jandre v. Physicians Insurance Co of …
Scope
- The second exception applies when disclosing medical information would pose a threat to the patient. If, for example, a patient has become so emotionally distraught that he or she would become incapable of making a rational decision, courts generally do not require disclosure [15]. If disclosure is likely to cause psychological harm to the patient, a physician does not have a duty t…
Introduction
- In most states, physicians are not required to disclose specific information about themselves [18]. In Johnson v. Kokemoor, however, the court held that a physician may have a legal duty to disclose his or her level of experience with a given technique when a reasonable person would expect to be told this information. The case arose after a patient suffered complications from a…
Preparation
- Given that requirements for informed consent are relatively vague and undefined and the exceptions are few, it is in the physicians best interest to inform patients thoroughly about proposed treatment options, ascertain that they understand their choices, and secure their consent. Doing so will help provide quality patient care and avoid exposure to legal action.