FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

DON'T SIGN "INFORMED CONSENT" UNTIL SURGEON ANSWERS ALL QUESTIONS

Question: I've been having a great deal of back and leg pain. The surgeon says I have a ruptured disk and that I need surgery. I signed a consent form for lumbar laminectomy and micro discectomy, but I only briefly got to talk to my doctor about the risks of this operation. Is there danger of injury to my spine or of being paralyzed?

Answer: Your letter highlights two important issues: One is the anxiety that we all experience when faced with having any type of surgery or procedure performed. The other is how can we become informed in a way that will help us to truly understand the risks involved in any given procedure.

We physicians are like most people who do a given task over and over again. It becomes second nature to us. Certainly that is a good thing if you are considering the technical skills necessary to perform an operation such as your planned back surgery. The negative side of this is that it is sometimes difficult for the doctor to remember that many people do not have even a basic understanding of the subject in which he or she is so intimately knowledgeable. As a result, your doctor may breeze over the relevant issues, often using a vocabulary that is not easy to understand, thinking that all has been clearly explained.

You have a legal and ethical right to know what the doctor plans to do in the surgery. You should understand not only the desirable end result of the procedure -- obviously, this is the reason for doing it -- but also the potential problems that can arise. The discussion should include the common problems as well as the uncommon ones if they are potentially serious.

For your planned back surgery there is certainly a risk of sufficient bleeding to cause anemia afterwards and also a risk of infection within the skin. These are not common consequences, but common enough to talk about. The more serious complications of surgical damage to a spinal nerve or infection within the bone are fortunately uncommon. Death caused by the necessary general anesthetic is rare, but if it happens to you or a loved one, statistics are not much comfort.

You should discuss these sorts of issues with your doctor before you sign any document giving permission for surgery. Some surgeons use specially trained nursing staff, or videotapes, or written material to help explain the risks of each procedure they perform. That is OK as long as you end up with a clear understanding of the risks involved.

I'll offer two hypotheses about your informed consent experience. One is that your doctor didn't explain any of the potential risks to you. He or she only talked about your need for the surgery and asked you to sign the form. I am suspicious, however, that your doctor quickly reviewed these surgical risks with you just prior to asking you to sign the consent form. You were focused on the news that you needed surgery. You didn't interrupt his or her presentation to clarify the magnitude or probability of any adverse experiences. By the time you got home you had recovered from the shock of hearing that you needed surgery and then realized you had more questions.

Regardless of the specific reason you didn't have all your questions answered initially, don't proceed with surgery until you do. The extra information will not change the outcome of your surgery one bit, but it will allow you and your family to understand not only the anticipated benefits but also the potential undesirable consequences. Then your consent for surgery will be an informed one.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.