Only the ophthalmologist who will do the surgery may obtain this patient's informed consent. The rule is plain. Informed consent for a procedure or treatment can be obtained only by the physician. Your booklet and your answers about eyedrops were part of the consent process, but they are not the consent itself. An assistant prepares and educates the patient. The surgeon discusses and obtains.
Informed consent rests on patient autonomy. That is the patient's right to weigh the facts and decide what she will allow. To decide, she needs the planned procedure and its expected benefit, any reasonable alternatives, and the possible adverse events in detail. She also needs to know how to prepare and what to expect afterward. She must get the chance to ask questions before she signs. Some patients say they would rather not hear the risks. That wish does not relieve the doctor of explaining complications and alternatives. Tell the doctor if the patient seems anxious. He may then give the information in broad terms. If you think a patient cannot understand the choice, report that to the surgeon. The surgeon judges whether she is competent to consent. A relative who holds medical power of attorney may then help her decide.
You may answer simple questions and write down the ones you cannot answer. Making a diagnosis or advising treatment on your own is the practice of medicine. Doing that without a license can even lead to criminal charges. So never obtain a surgical signature on your own. Knowing who may take consent belongs to the COA content area on medical ethics, legal issues, and regulatory issues.
Incorrect Answers
- A. An assistant may teach the patient and hand out materials, but may not obtain the consent. That step belongs to the physician alone.
- C. A scheduler books the operating time and gathers paperwork. She has no license to discuss risks or alternatives with the patient.
- D. A manager may witness the signature in some offices. Witnessing a form is not the same as obtaining consent.
Testing Pearls
- Only the physician may obtain informed consent; the assistant prepares and teaches.
- Consent must cover the procedure, expected benefit, risks, and alternatives.
- The patient must be able to ask questions before signing the form.
- A patient's wish to skip the details does not excuse the doctor.
- If capacity is in doubt, tell the surgeon; a medical power of attorney may help.
References
- American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 20, Medical Ethics, Legal Issues, and Regulatory Issues.
