“MyDoctorNeverToldMeTHATWouldHappen!”

APa:ent-CenteredApproachto

InformedConsent

Real-WorldApplica:ons

“DoctorKnowsBest”•  Visually-significantptosis•  Nocontraindica:onsforrepair

“You’retheDoctor.Whateveryouthinkisbest.”“IfIwereyour____whatwouldyourecommend?”

Pa:entKnowsBeQer•  Handoutliterature•  Writedownsearchterms,websites•  Talkwithotherpa:entsorfamilymembers•  Returnwithfamilymember,advocate

•  Mostpa:entsfollowouradvice:treadcarefully

“LikeFather,LikeSon”•  Dimytriis2monthsold•  Developmentalcataracts•  Dadhadthemtoo,Ukraine•  “Idon’twantmysontogothroughsurgery”•  “Thereareworsethingsinlife.”

RightofRefusalandSurrogacy

•  Extrac:onisinDimytri’sbestinterest•  Pa:ent,consen:ngpartyarenotthesame

Towhomisthephysician’sduty?

Strategies•  Pa:enteduca:on,websites,founda:ons•  Partnerwithanotherfamilymember•  Engageanotherfamilywho’sbeenthere•  Returnvisits•  HospitaladvocacycommiQee•  Legalinterven:on(lastresort)

“NotinMyBackyard”•  Pa:entneedscataractsurgery•  Seenatlargeteachinghospital•  Goodsecond-yearcase•  “IwatchGrey’sAnatomy.Noresident’scu^ngonme.”

Findings•  95%pa:entswantedtoknowrankoftrea:ngM.D.•  56%understoodAQendingvs.Fellowvs.Resident•  52%wouldsaynotobeingresident’s1stLP

–  36%wouldsaynotoevenresident’s10thLP

Thoseleastinformedaboutmedicalhierarchywereleastcomfortablewithresidentinvolvement

StudentDoctor•  Pa:enthasrighttoknowandchoosewhowilltreat•  Manywillconsideritanhonor•  Others,notsomuch•  Limi:ngtraineeinvolvementatoddswithmissionofteachinghospital

•  AQendingcanagreetopa:entchoiceorreferoutsideteachingins:tu:on

“EyeoftheBeholder”•  44-year-oldKoreanhedgefundmanager•  Treatmentfor“:red-looking”eyes•  Nolidcrease•  Motherwithsimilarappearance,corneasnearlyhiddenbyexcessiveskin

•  Seesprominentplas:csurgeon•  Localcelebrityglossyphotos,“BestDoctor”magazinecovers,cherrywood,moodligh:ng

•  Surgeonaffable,detailsR/B/Aofupperblepharoplasty,answersques:ons

•  Pa:entleavesconfidentinsurgeonchoice

•  Unevenlulsurgery,standardlidcreaseincision,lidcreasereforma:onsutures

•  POD#7,swollen,bruised,FBSbuto/wOK•  POD#14,traceswelling,bruising•  Frontdeskstaffcomplimentaryofnewappearance

•  Surgeonishappywithresults•  “Nowyouhaveaniceplacetoputeyeshadow!”

•  Pa:entbreaksdown•  “Idon’tcareabouteyeshadow.Iwantedtogetridofmy:red-lookingeyes,notmyKorean-lookingeyes!”

WhatWentWrong?Surgicaltechniquewithinstandardofcare

WhatWould(Asian)Pa:entWanttoKnow?•  It’sallaboutthecrease•  Placement,effectofincision•  Whatdoespa:entwant?•  Preserveracial/culturaliden:ty,resonance

•  Respectpersonal“blemishes”

InformedConsentChecklist•  Natureofprocedureexplained,inadvance•  MaterialR,B,As•  RisksofNOtreatment•  Timetoaskques:ons•  Abovedonebysurgeon•  Formissigned•  Copygiventopa:ent

ForExtraCredit•  Cogni:ve/mentalstatus•  Sensory,language,literacyimpairment

•  Interpreterprovidedifnecessary•  Pa:ent“teachback”•  Presenceofothersdocumented

ForExtraCredit•  Natureofrecoverydiscussed•  Roleofassistants,reps,residents•  Post-oproleofassistants,residents,otherproviders

•  Physicianinexperience•  FDAapprovalandofflabelstatus

NobodyLikesSurprises

YouCannotPreventLawsuit•  ButyouCANmakeyourcasemoredefensible

InformedConsent•  PROCESS•  pa:entautonomy•  Riskassessment•  Ra:onaldecisions

Founda:onforhealthyphysician-pa:ent

rela:onship