* * Anonymous Doc: Consenting the unconsentable...

Tuesday, January 10, 2012

Consenting the unconsentable...

4:30 and the day is going almost too well.

Until I hear a scream coming from a patient room.

"You amputated our mother's LEG?"

"Well, not me, personally. But, yes, your mother needed emergency surgery. It's unfortunate, but, I promise you, without that surgery, your mother would not be able to survive. The infection was too profound. ... But I was under the impression you knew about the surgery."

"You think I would have gone to work today if I knew about this surgery? I would have been right here, with my mother! I did not know a thing about this surgery!"

"I was told we had consent..."

"Not from me, you didn't."


"Hey, med student, the patient with the leg amputation-- you informed the family and got consent, right?"

"Oh, I got consent, absolutely. But I forgot to call the family. Is that okay?"

"Not really, but first-- who did you get consent from?"

"The patient. Obviously, right?"

"The patient-- who has at least some level of dementia?"

"No, no, she totally understood what I was saying. I explained everything, answered any questions, and she signed the papers. I thought she totally knew what happening."

"Did she ask any questions?"

"Not really."

"And she signed the paper, with her name?"

"Well, it was sort of a squiggle, but it looked like her name, yeah. I just thought that was her signature."

"And you didn't call the family?"

"We were rushing her into surgery-- I barely had time to talk to her before transport came-- and I had three other patients to write notes on-- I was going to call them later."

"They missed the surgery. It went well, but-- you have to call the family if the patient is having surgery! What do I tell this woman's daughter?"

"But they had to do the surgery no matter what-- it was an emergency."

"I know. But how would you feel if it were your mother?"

"I don't know."

"Okay, I'm going to talk to the family. Even when families are difficult, we really want them on our team, and we really want to take pains to keep them in the loop when someone is having surgery."


  1. Med students are allowed to get consent at your institution?

  2. And this is why med students should never get consent. We don't always know all the risks, the best way to explain surgeries or the proper procedures and the legal ramifications of not following those procedures. We are not employees, so it is not our job to do so. Our job is first to learn, then to be helpful.

  3. I was never allowed to get consent at my hospital as a clerkship student. Maybe I was as a sub-i? Can't remember. But whoa. I hope the patient and her family are able to forgive the lapse....

  4. Jeez. I was never allowed to get consent, for pretty much this exact reason.

    Hope nothing major comes of this!

  5. Ouch. I agree with SR on this one. As a med student I was sometimes asked to get consent for surgeries that I barely understood. I would almost always drag a (usually unhappy) resident in with me because I didn't have a good grasp on what the risks and benefits were.

  6. Yeah, pretty much... I was starting to think that my experience was absurd. Never involved in consent as a 3rd year. I remember "getting consent" once or twice but never alone; there was always a resident with me to step in if there were questions I couldn't answer, etc., and it was never a "go get consent on Mrs. Smith" it was a "let's go get consent on her... this will be good practice for you" sort of thing.

  7. And this is why med students should not be allowed to get consents. I never have gotten a consent from a patient, and I'm almost done with med school! I've only acted as a witness, or translated info into Spanish. Crazy!

  8. Oh, we let everyone get consent-- med students, nurse's aides, transport folks... it's the wild west over here. No, actually, all of these responses have me double-checking the interns are actually accompanying the students for everything.