Putting Patients at Ease
Zara Patel, MD, assistant professor of otolaryngology-head and neck surgery and an expert in advanced endoscopic sinus and skull base surgery at Stanford University School of Medicine in Palo Alto, Calif., said that while patients want to know the risks of a procedure, it is incumbent on otolaryngologists to deliver the news in a way that avoids overly medical terms and minimizes anxiety. Of course, that conversation can be particularly difficult with rhinology procedures that involve operating in proximity to the brain and eyes.
“I go into specific risks regarding the area in which we’re working,” she said. “So, specifically for sinus surgery, I say, ‘You just want to remember that we’re working right around the eyes and right underneath the brain, and so, because we’re so close to those structures, I have to tell you that they are “at risk.” But, knowing the overall risk of those potential complications is less than 1% overall, you can feel comfortable that it’s really a minimal risk’ … Presenting it in that sort of fashion allows the patient to understand that [potential complications are] there, but they’re not some major thing that always happens that they have to focus on.”
Dr. Patel, who is also a co-author and editor of the textbook Office-Based Rhinology: Principles and Techniques (Plural Publishing Inc., 2013), said that while one reason for the process of informed consent is to protect the physician from liability, that is not the main purpose. Patients need this process to truly understand and weigh all the risks and benefits of their choice, and they can be frightened by jargon and confused by terms they’ve never heard.
Mostly, she said, patients just want to be comfortably prepared when facing a procedure. “Telling the patient how many of these procedures you have done can put them more at ease—and letting them know it is a very common procedure,” added Dr. Patel. “Often, when we do sinus surgery, we use computer-guided navigation, and that can also make them feel a little bit more assured about it, even though there hasn’t been any evidence showing that its use decreases risk at all. … All those things kind of come into the conversation to allay their fears.”
Dr. Wolf said the best way to ensure that a patient’s consent is truly informed is to build a relationship. He noted the old adage that the best ways to avoid getting sued are “affability, availability, and ability—in that order.”