Surgical Consent: Fill & Download for Free

Frankly, in residency at a charity hospital in Louisiana it was not unusual (2–3%) to meet patients who couldn’t read or write. These individuals would sign the surgical consent form with an X with multiple witnesses. Coming from the North East I found this stunning.When interviewing for the position I was asked “You do understand the type of patients we treat here, don’t you?”I responded “I expect you are a tertiary referral center much like the University of Maryland school of medicine”.The interviewer said “We treat a lot of ignorant ****** people here.”My North Eastern response was “I understand you have a lot of uneducated ***** patients here”.We both knew what we were saying, smiling at each other. Unfortunately he was more correct than I.Fortunately things 25 years later are different.

I had a patient once decide on the day of surgery not to go through with the surgery because she’d had thousands of dollars worth of dental work done and the anesthesiologist had told her there was a small risk of breaking a tooth with intubation if she needed to be intubated. It was completely irrelevant to the reason for the surgery, but she decided that was enough reason to cancel.I remember once having a patient with really exceptional anxiety who wanted surgery and knew she would benefit from surgery, but she was terrified of having surgery. We had discussed the ins and outs and details exhaustively in the office, and settled her worries as much as I thought we could, but then on the day of surgery, unsurprisingly, her worries were far more tangible to her because she was in the hospital. Her partner was instrumental in helping to ground her and ultimately help her to decide to proceed. I was very clear that this was her decision, outlining pros and cons and risks etc.On a couple of occasions I’ve had it go the other way. I’ll have a patient in pre-op holding who asks me to do something else they were too embarrassed to bring up in the office or with an interpreter. So we have another full informed consent discussion and add it to the surgical consent (or not if it doesn’t seem appropriate).The patient is absolutely the driver.I have heard stories of patients having objections or questions and being railroaded into proceeding anyway. Not how I operate and not how I think anyone should.

No.Surgeons and operating room staff have a process called “time out” that is taken very seriously to ensure that the correct patient gets the correct operation on the correct side.That does not mean there aren’t errors, but they are extremely rare. Mostly wrong side errors. There is a famous Florida case of a surgeon amputating the wrong side leg, but even in that case there was severe disease on both sides. It was not an issue of a doctor cutting off a healthy leg and leaving a diseased leg.The concept of taking out the wrong organ is very difficult to fathom. That would imply that the complete wrong operation was done. A splenectomy removes the spleen; if a doctor pulled out a length of bowel instead of a spleen it just wouldn’t make sense….lucky for me I operate on the brain so there isn’t any other organ in there to cause confusion :-)That being said, there is a clause in every surgical consent that I have ever seen that includes the concept that the surgeon can do other procedures as necessary to preserve life and function. I describe this carefully to the patients with examples depending upon the operation. For example, when gaining consent for total cervical disc arthroplasty (remove a worn out disc in the neck and replace with an artificial joint), I mention that if the esophagus was damaged I would have an ENT surgeon come in to fix it. So, with pure conjecture on my part, maybe you could hear about a plan to remove a galbladder and find the spleen was removed….presumably damage occurred to the spleen and the surgeon felt it better to take out than leave a damaged organ. Other than something like that I just don’t think the “wrong” organ would be removed.