Uninformed Consent Costly For Patients?

Americans May Be Driving Up Medical Costs By Consenting To Unnecessary Medical Procedures

(CBS)  Fifty-five year old David Jordan suffered a heart attack. His doctor suggests an angiogram to see if a blocked artery needs to be opened up by angioplasty.

But does Jordan really understand what he's consenting to? Research shows patients often don't have a clue - and may end up having a procedure that doesn't help-and may even hurt them. A frequent example? Angioplasty when you're not having signs of a heart attack.

---

Business Week: Giving Patients the Data They Need

---

"It's used much more than it needs to be or would be if patients were adequately informed," says Dr. Elliott S. Fisher, Director of the Center for Health Policy at Dartmouth. "Forty percent of the elective procedures are unnecessary," he said.

Most patients think non-emergency - or "elective" - angioplasty will make them live longer. In one report, eighty-eight percent thought it would prolong their lives by about ten years.

Dr. Fischer disagrees.

"Elective angioplasty doesn't reduce your risk of death. It does not reduce your risk of heart attack," he continued. "That's a huge amount of money being wasted on a procedure that could only carry risks."

Fisher says proper informed consent would eliminate thirty to forty percent of other overdone procedures like angioplasty, spinal fusion, knee replacement, and hip replacement.

The problem starts with consent forms. A review of hundreds of consent forms like at more than a 150 hospitals found them to be of quote "limited value." They are not standardized, they're loaded with confusing language, they’re often missing specific risks, and generally not well explained by doctors.

David Jordan’s doctor, Dr. John Robb of Dartmouth Hitchcock Medical Center, says "The key is to involve patients in decision-making."

Jordan is part of a pilot program at Dartmouth, which is personalizing the process. It starts with taking a detailed medical history: such as age, weight, and overall health. By searching a database of angiogram results, doctors can then estimate your individual risks and benefits by finding out what happened to patients just like you who had the same procedure.

"It's not generic - it's for people like you. If we get that right, we'll create a better informed consent," says Gerry O'Connor, associate Dean for Health Policy and Clinical Practice at Dartmouth.

A boilerplate consent may not offer the average risk of death - let alone his risk.

Another innovation? Interactive patient aids. Over 100 hospitals nationwide use a 30 minute video to help prep patients on the risks.

Ultimately, Jordan didn't need a stent. But his case illustrates the value of a new personalized consent process that encourages - even forces - doctors to consider "is this procedure right for this patient?" It's especially important because so many people do whatever the doctor says.

The goal is less risk and less waste by making doctors and patients partners in the decision making process.

[everet3]

I went shopping so to speak for an ENT that does ear implants after the medical doctors gave me this virus I have through a blood transfusion ( hepatitis C ) and then they gave me the medications that took my total hearing away in both ears, by giving me the wrong drugs that the FDA says should not be given together. You want to know something? 5 out of 6 of the doctors that does the implants have refused to give me the right to hear again. They, all 5 of them said they would not operate on someone that has hepatitis C. I have an appointment with the 6th doctor on the 7th of july, and even though my wife told them I had hepatitis C and they said they would do the operation anyway, We have not told them that once I was on the transplant list. I'll just bet they use that as a reason. I have a good mind not to say anything. ( see posted by Everet3 ) It's not like I haven't had surgery since I was removed from the list, in the middle of June I had a hernia operation. They kept me under for about two hours. But you'd think the medical community would be more than happy to try and repair what their brothers in the white coats have done. All I ask for is the right to hear my wife and daughter tell me how much they love me before the hepatitis C virus they gave me back in 1972 does kill me. They have the God given gift, why do they only use it on the rich and people that are clean of any viruses? Are they that careless with the knife? Or are they not that sure of them selfs?

[number1GI]

skeezix06 I think you are wrong. All illnesses are not alike. all deseases are not alike there fore how can all care be alike?
If Cancer were the same would not a cure been found by now?
There is a Medical Center in Duarte , CA that is doing research on the many different types of cancer and its treaments This hospital is like a huge City. It gives it patients lots of Hope. They care for their patients on an individual need, not one treatment fits all .
The care given by the world class nurses is nurturing and warm giving the patient feeling of hope.of a long survival time .

[everet3]

Back in 2001 I was placed on the UNOS transplant list, but in 2007 I was kicked off that list because I found out that they had been feeding me Neomycin-Sulfate along with Furisomide. Which the FDA plainly states should not be given together to some one with liver damage. They were giving it to me twice a day, but did not inform me that the two drugs can and will take away your hearing, which is just what it had done to me. I'm now totaly deaf in both ears. They were also giving me Ciprofloxin which will tear your tendons apart. All with out my concent, when I complained, I was removed from the tranplant list with a bunch of lies. One being that I was missing to many appointments. My wife needed major surgery so I had contacted my nurse cooridnator who told me to be with my wife and any appointments that may come up that she would move them until the end of March or early April. And one of the other lies was that I was running around looking for drugs just to get high on. I have all the e-mails from her to prove this, I was given a MELD test every three months. A MELD test is where they take blood from you to see how your liver is functioning, It also tells them if there are any drugs that they did not prescribe in your blood. I have another email from her that states that my MELD score was doing so good that they did not need to see me every three months, but just once every seven months. As I said I have all this in e-mails from her to prove what I am saying is true. Also another e-mail was that UNOS passed a new rule that states that I was to old to be on the UNOS waiting list. I went to the only other transplant center here in San Antonio, TX and they told me this was a lie UNOS never passed such a law. So I have lost all my hearing in both ears because of drugs they gave me that the FDA said should not be given together, and I constantly have torn tendons because of the Ciprofloxin they were giving me, again because of drugs they gave me. I have lost all my teeth because I had one bad tooth which could have been fixed. Then because of more lies I was removed from the UNOS and transplant centers lies, I will now die because of them. I was told this nurse is no longer working at the center. Isn't it funny a man will die because of a nurses lies trying to keep her job, but lost it anyway. And I cannot find a lawyer to take on the case because as I was told that the center was the bread and butter of this town. But I still pray for them every night.

[sam-kiley]

bonsoir,
personnaliser la procédure, voudra dire agir par priorité", par élimination,ne pas laisser la meme chance de soins pour tous les malades, chacun et selon son cas a droit aux soins, réduire le cout des soins reste essentiel, quand aux erreurs médicales elles existeront toujours, et seulela bonne prise en charge, la conscience du personnel medical, pourront aider a réduire ces erreurs et limiter les dégats

[johnsole1]

I work for an attorney who makes $300.00 ++ an hour with next to no government or third-party oversight as far as rates go. My OB GYN quit delivering babies because his net profit after nine months of care of baby momma and delivery was less than $300.00. Insurance companies tell Docs what to diagnose, what to charge, what drugs can be prescribed, and if a patient may be admitted to the hospital and then when to discharge. All this has done is lead to a major decrease in available services. Docs can make more money shooting a face full of botox than they can providing real medical services all because of our out of control insurance industry.

[texanforlogi]

Posted by drivelphobe at 12:29 AM : Jun 10, 2009

Excuse me, but health care certainly is a right. Obama's answer to this question in the affirmative is a big reason he was elected.

Driving a car is a privelege, but health care is a right. It is necessary to the effective functioning of a human being.

I regret that you seem to feel that only those with money should have access to health care, but I'm not at all sorry that things are not going your way in this area. Your elitism is showing and it isn't pretty.

[hlthinfopro]

The story, while a good one, suffers from this glaring omission: the Joint Commission on Accreditation of Hospitals (TJC) mandates that the patient's record contain clear documentation of patient/family involvement in healthcare decision-making, including the plan of care, safety concerns, and informed consent to procedures. By informed consent is meant not just a signed form, but evidence of a discussion with the physician of risks, benefits, and exactly what the procedure entails. As a 35-year veteran of the health record profession, I find it appalling that the story did not cite this Joint Commission standard.

[geeacestar]

I am an attorney who represents healthcare providers and I have tried several dozen claims involving medical malpractice and "lack of informed consent." I have taken this knowledge and, this last March, I presented a book chapter on safe informed consent systems for the Pennsylvania State Bar. (This topic was also addressed in a national publication.) Systems are necessary to police the lines of communication between provider and patient, but unfortunately, no one in the healthcare industry seems to be interested. There is so much waste. I sure could have some fun if I were a plaintiff lawyer.

[drivelphobe]

Physicians and hospitals are forced to use every legal avenue to charge for services. Since they are unable to deny care to indigents and illegals, they must extract every nickel possible from any system that provides reimbursement. That means private health insurance, medicaid and medicare.

Until illegals and those without insurance can be denied care, we are all screwed. Just be happy you can get any care at all. If Smokey O can force through his free care for everyone, there will be minimal care and shoddy care for all.

The smart people are enrolling as private patients with a doctor for a fee starting around $2000 per year and up, depending on the doctor's patient load. This fee only gets you the doctor. All medical expenses still have to be paid either with insurance or with cash. Health care is not a right. If you expect anything other than a life saving treatment in an emergency, you better be able to cough up some money.

[lucas122679]

Speaking of unnecessary procedures, male circumcision is also a costly and unnecessary medical procedure that's confirmed without the consent of the patient. As a nation we denounce, we decry, we protest against female genital mutilation, yet when it comes to whacking off or genitally mutilating our boys, no one blinks an eye, it's no big deal, it's just something we "do" here because foreskin is gross and difficult to clean. Parents, why not teach your sons to wash "that" area just like any other area of their body and let the circumcision decision be THEIRS?

[lucas122679]

Speaking of unnecessary procedures, male circumcision is also a costly and unnecessary medical procedure that's performed without the consent of the patient. As a nation we denounce, we protest against genital mutilation being forced upon females, but when it comes to whacking off or genitally mutilating our boys for no religious or medical reason other than "foreskin is ugly and difficult to clean" not only takes away a boy's right to chose whether or not he wants to be circumcised, but it's quite shallow on the part of parents.

[tincup356]

Uninformed consent in a hospital is about the same thing as writing them a blank check and signing it for them,,,,,,,Hospitals and doctors are WORSE than the credit card companies when it comes to gouging people.,,,they are ALL crooks.

[skeezix06]

This is about standardization of care. It is about guidelines that you as a patient must meet before they agree to do anything for you. It is not that much about giving care that is based on individual needs. Hospitals have regular reviews of procedures and things like unnecessary operations are on that list. I'm surprised Dr. LaPook forgot to mention that fact.