Uninformed Consent Costly For Patients?

During angioplasty, a clogged blood vessel feeding the heart can be opened up with a tiny balloon and a stent placed to keep it from closing.
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.