Reply to the Letter to the Editor: Medicolegal Sidebar: Who Should Obtain Informed Consent?

To the Editor,

On behalf of my coauthors, I would like to thank Rickert and colleagues for their comments on our column [1], and for furthering the discussion on informed consent. The authors of the letter correctly note that informed consent is an important process, rather than an isolated step, in the dialogue between physicians and their patients. Not only should the dialogue be accurate in terms of explaining the planned medical intervention, but it should also capture a discussion of uncertainty and address patient expectations, as the authors have pointed out.

My coauthors and I believe that the surgical community should independently decide who should obtain informed consent, as well as other matters directly related to patient care, rather than rely on courts to set rules for physicians. Our concern is that if the surgical community delegates informed consent decisions to the courts, we may face a slippery slope in the future. For example, while informed consent is important to patient care, so is the history and physical examination. Should courts require that the traditional history and physical examination be performed exclusively by physicians and not delegated to anyone else? After all, the history and physical examination is a key medical instrument that captures vital patient information. The history and physical examination is accessed not only by the physician, but by other members of the team, who rely on an accurate and timely capture of information to ensure proper patient care.

If a future judicial decision stipulates that the history and physical examination must be done exclusively by the physician, should the updated history and physical examination, which is commonly required by hospitals on the morning of surgery, also be done by the operating surgeon, rather than a physician assistant or nurse practitioner? We still need answers to these questions, but they illustrate our concern that leaving decisions concerning medical authority and attendant decision-making to adjudication by judges and lawyers does not serve our profession well in the long-term.

I suspect that many physicians will agree with Rickert and colleagues regarding the importance of informed consent and that it should not be delegated to anyone else. This culture of ownership should be fostered through education and seminars. Certain practice guidelines, for example, have already been developed to guide young physicians about clinical care. Similar guidelines would be helpful for the informed consent process as well.

On behalf of my coauthors, we agree whole-heartedly that informed consent is a critical and vital component of patient care and should properly be done exclusively by the physician. But this realization should come from the medical profession itself.