iCONSENT
CONSIDER THIS POEM BY Aurora Levins Morales
“Patients”
Why do they call us "the patient"
We are not patient. We endure.
The anxious tedium of public hospital
waiting rooms, because waiting
is the punishment of the poor;
interminable buses to inconvenient places
where we count up our cash, calculating
whether we can take a cab home
instead of riding our exhaustion;
the angry contempt of specialists, taught to believe
any pain they cannot explain is insubordinate,
deliberate, offensive.
We are not patient. We are denied.
Not medically necessary, they say, not proven.
Feel free to appeal. We are experts at appealing,
so we begin again, gathering documents, faxing releases,
collecting letters and signatures,
giving our numbers, all our numbers,
to dozens of indifferent, underpaid clerks,
stacking up evidence for the hearing, where we will declare
as civilly as we can to the affronted panels
that it is necessary that we breathe,
sleep, digest, be eased of pain, have medicines
and therapies and machines,
and that we not be required to beg.
While I am waiting, I am using my pen,
steadily altering words.
Where the card says "medically indigent"
I cross it out and write indignant.
Where my records say "chemically sensitive"
I write chemically assaulted, chemically wounded,
chemically outraged. On the form listing risk factors
for cancer, I write in my candidates: agribusiness,
air fresheners, dry cleaning, river water, farm life,
bathing, drinking, eating, vinyl, cosmetics, plastic, greed.
I am making an intricate graffiti poem
out of mountains of unnecessary paperwork.
Where the doctor has written "disheveled" I write untamed.
Where it says "refused treatment," I write refused to be lied to.
Where it says safe, side effects minimal
I say prove it. What do you mean minimal?
What do you mean side? I write
unmarketed effects unmentionable.
Where it asks, authorization? I write inherent,
authorized from birth.
Are you the patient? she asks, ready to transfer my call.
I say only with my own sweet, brave body.
I say, Not today, no. I have no patience left.
I am the person who is healing, I say,
in spite of everything. I will have to put you on hold she says. Yes,
hold me I say. That would be good.
Questions for reflection or group discussion
Have you or someone you know ever felt like the patient in this poem?
If you their clinician or the person who answered the phone, what would you think about this patient?
How would you change the interaction?
LET’S TALK ABOUT INFORMED CONSENT….
Why practice compassionate consent?
Consent is at the heart of our relationships with patients. It allows us to establish rapport, answer questions, address concerns, and set expectations.
Unfortunately, studies suggest consent practices are limited with only an estimated 57% of patients feeling they received sufficient information to make an informed decision. An observational study of thousands of consent conversations found only 9% met criteria for informed decision making and a review found 21-86% of patients could recall the risks of their procedure.
This matters not only ethically but because miscommunication about procedures is a leading cause of lawsuits and poor outcomes.
CONSENT - A MISSED OPPORTUNITY
Consent conversations are an opportunity to connect with patients and families and advocate for them. We sometimes miss this opportunity, treating consent as a checkbox and rushing through it with canned speeches.
On average, patients will speak for 91 seconds uninterrupted, yet clinician have a tendency to interrupt after 22 seconds. If we invest a little extra time upfront in these conversations, it can save time in the long run, improve adherence to the medical plan, and decrease frustrations if/when complications occur.
Those most vulnerable to uninformed consent are those with language, cultural, and social barriers such as minority groups and those with limited health literacy and numeracy.
CONSIDER THIS PAINTING BY Sir Luke Fildes
“The Doctor”
Questions for reflection or group discussion
What do you see in this painting?
What do you think the doctor is feeling and thinking?
What do you think the other people in the room are feeling and thinking?
iCONSENT - MAKING INFORMED CONSENT AN INFORMED CHOICE
We designed this curriculum because there is little formal training on best consent practices beyond medical school. We are all busy so we have tried to make the curriculum complete and practical. It can be used as a quick reference, guided course, or more formal curriculum for a group supplemented with artwork, poems, and other resources for further reflection and discussion as desired. Help us make informed consent an informed choice.