Informed Consent

• Components of Informed Consent
  • Capacity
  • Disclosure of information
    • Details
      • The procedure for which the patient is being consented: The procedure should be explained in detail, including positioning, incisions and the basic steps of the procedure.
      • The indication for procedure: Why the procedure is being done?
    • Benefits
      • Benefits of the procedure: What are expected success rates? Why is this beneficial to the patient over other options?
    • Risks
      • Potential risks of the procedure: Care should be taken not to over- or understate risks.
      • What to expect post-procedure: including recovery, bleeding and would healing.
    • Alternatives
      • Alternatives to the procedure: including no intervention.
  • Voluntariness
  • Authorization
• Language tailored to patient needs
• Presenting information in balanced fashion
• Invitation of questions
• Verification of understanding
• Sometimes discussing the alternative is key
  • Balance information
  • Understating
  • “Scare tactics”
• The “right amount” of information to give is a forever moving target
• Does not preclude recommendation!
  • “In this situation we would typically…”
  • “Standard practice would be… and here’s why…”
  • “Based on what you’ve said about wanting to feel better as fast as possible I would recommend…”

Error Disclosure

• Patients Preferences
  • Error occurred
  • What happened
  • How it happened
  • Expression of concern
• State facts without blame or conjecture
  • What happened
  • Consequences
• Express Empathy
• Align that goal is best possible care
• Apologies
  • Helpful part of being a human (empathy and contrition)
  • Blameless apology
    • “I’m really sorry that this happened”

Trauma-Informed Care

Questions to ask

• Since the last time I saw your child, as anything really scary or upsetting happened to your child or anyone in your family?
• You have told me that your child is having some problems with x… Just as fever means the body is dealing with an infection, when these behaviors happen, they may mean that the brain and body are responding to stress or threat. Do you have any concerns that your child is being exposed to a threat or feeling stressed?

Trauma symptoms: bodily functions