The Evolution of Informed Consent

Whether relying on the professional standard or the “reasonable person” criterion for informed consent, the question of how much information to share with patients to fulfill the obligation of informed consent remains controversial. “Should we mention all possible risks, even the super rare ones that could unnecessarily worry patients? Or should we simply mention the common ones?” asked Dr. Hong.

According to William McVisk, legal counsel for the American Board of Otolaryngology, clinicians are typically only required to inform patients about the most significant risks of a procedure and not about the many remote risks. “Most procedures have a lot of risks, and you’re not required to inform the patient of every single one of those risks, because you could spend a couple of hours doing so,” he said, underscoring that his perspective is that of an attorney who practices in a state in which informed consent is defined by the professional standard.

One challenge that physicians should keep in mind, according to Dr. Hong, is evidence that patients often get different information from different sources and can have poor recall as to what they’ve been told about the potential risks and benefits of a procedure. “The challenge is that patients hear different things from different surgeons, and they also likely hear and read different information from family and friends and on the internet, which could lead to confusion and poor understanding of their surgical procedure,” he said.

Dr. Hong and his colleagues found evidence of this disparity in a prospective study they published in 2016 that evaluated recall of surgical risks and benefits in 84 parents of children who underwent consultation for adenotonsillectomy and/or tympanostomy tube insertion (Otolaryngol Head Neck Surg. 2016;155:332–339). The study found that only one-third of parents recalled the risks of surgery discussed during the informed consent consultation. An even more important issue, said Dr. Hong, is the finding that the risks and benefits discussed by one surgeon often differed from those mentioned by a different surgeon.

He suggested that surgeons should adapt their discussions around informed consent to each individual patient depending on need. “I think the surgeon should take each interaction separately and try to determine how much (or less) information should be shared with the patient so that they are well informed,” he said.

McVisk advised otolaryngologists to make sure they inform each patient of the important risks of the procedure and to document in the patient’s chart or medical record that they discussed the risks, noting which risks were discussed.