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Message from the Chair

“Extra! Extra! Read all about it.”

This issue of the Digest may have some of the most practical information you’ll ever find on arguably the greatest global risk management issue in medicine: informed consent. When not managed properly, informed consent deficiencies can create trouble and misery for patients and physicians alike. A recent review of our own claims shows allegations of improper informed consent are over 50% more likely to result in a plaintiff award with damages that are substantially higher as well. Why is informed consent so critical? When we don’t take the time to properly educate patients about the pros, cons, and alternative options of the medical treatments we provide, we open ourselves to claims that they would have refused treatment had they been adequately apprised of the risks.

When things go wrong, there are two groups of patients who are more likely to allege improper consent: those who tend not to question the recommendations of their doctors and those who have strong—and potentially unrealistic—expectations for their clinical outcome. These are people who may have low health literacy (not to be confused with IQ) and need more explanation and education on the potential consequences of any medical intervention. In these situations, it is especially important that informed consent and patient instruction are not just thorough but meticulously documented. While it is neither possible nor practical to list every conceivable risk, the most common and the most catastrophic potential adverse events are a good place to start. Forms that use plain English and emphasize the active voice are most understandable, e.g., “Take your drops twice a day,” versus “Topical medications should be used twice daily.” Note in the record what patient education materials were given out. These resources serve as “extenders” of your informed consent discussion. Keep copies of these handouts as they will be powerful evidence in our defense of you should you be sued.

Feeling overwhelmed? We are here to help. OMIC has scores of procedure-specific consent forms—downloadable and customizable—that are now, through a partnership with the Academy’s Foundation, also translated into Spanish. Just a click away at www.omic.com, these forms combine frank discussions on risks/benefits/alternatives with disease-specific patient education to help arm patients with information they need to feel confident in their medical decision-making. Also on the website is an informed consent webinar, “My Doctor Never Told Me THAT Could Happen.” We feel so strongly that proper informed consent will strengthen our defense of any litigation that we will give ophthalmologists a 5% to 10% premium credit just for viewing it. Looking for more patient education materials to supplement your practice? Check out the new and innovative multimedia offerings on the aao.org website.

Informed consent is part of the conversation that we have with our patients. It acknowledges the vagaries inherent in medicine and fosters a climate of candor, rapport, and trust that may very well represent the best weapon we have against litigation: a meaningful personal connection with the patients we treat.

Happy reading.

Tamara R. Fountain, MD, Chair of the Board