INFORMED CONSENT

Emergency Medicine physicians are expert diagnosticians, resuscitationists, and proceduralists. The process of obtaining informed consent from patients in our care is also an important part of our practice. The exception is acutely life-threatening situations when timely action is required to prevent death or serious harm, whereby consent is implied.

There are 3 components of informed consent in medicine:

1. Patient capacity to make a treatment decision
2. Information regarding the patient’s current condition, treatment options, and associated risks and benefits
3. Voluntary consent to treatment without coercion

Some pearls regarding informed consent:

• A signed informed consent form provides evidence that the discussion occurred but does not necessarily prove what was discussed.
• Consent can be revoked by the patient at any time for any reason, and past consent does not imply future consent for a similar procedure.
• Be honest with the patient about your level of expertise.
• If appropriate and desired by the patient, involve the patient’s family in the discussion.
• Unsure if the patient is on the same page? Use teach-back methodology, i.e. “Tell me what you know about this procedure after what we’ve discussed.”

These conversations are not easy in the chaotic ED, where time is extremely limited, and our patients are usually meeting us for the first time. This underscores the importance of gaining trust early in the physician-patient relationship – a skill cultivated by communicative and compassionate Emergency physicians.

References:

1. Magauran, B. (2009). Risk management for the emergency physician: competency and decision-making capacity, informed consent, and refusal of care against medical advice. Emergency Medicine Clinics of North America., 27(4), 605–14, viii. https://doi.org/10.1016/j.emc.2009.08.001

2. Moore, G. P., Moffett, P. M., Fider, C., & Moore, M. J. (2014). What emergency physicians should know about informed consent: legal scenarios, cases, and caveats. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine, 21(8), 922–927.