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Encouraging Patient Questions

By Jock Hoffman, CRICO

Related to: Communication, Cures Act: Opening Notes, Emergency Medicine, Primary Care, Informed Consent, Obstetrics, Other Specialties, Surgery


A recent article in the Boston Globe indicates that women who give birth in a hospital are not always asked permission before procedures, and that their wishes are not always respected. In particular, a survey by Childbirth Connection indicated that 20 percent of women felt either pressured or disrespected regarding induction of labor, cesareans for women wanting a trial of labor, and episiotomies.

The issue of hearing and honoring a patient’s preferences goes well beyond obstetrics. Over the past 10 years, 48 malpractice cases filed against CRICO-insured providers alleged that inadequate communication between clinicians and patients led to a medium or high-severity injury.

Our Recommendation

Patients who ask the right questions at the right time are better partners in their own care. But not every setting or situation is conducive to patients opening up. Do not assume silence is consent. You may need to guide your patients toward understanding what is about to be done and any options available. Make certain their wishes are heard, respected, and accommodated. Clinical concerns for the patient’s well-being should be addressed and documented, but an informed refusal is the competent patient’s right.

Informed consent is not limited to planned invasive procedures with measured risks and benefits. While routine and/or spontaneous procedures (e.g., imaging, drawing blood, applying a monitor, shaving) may not call for the patient’s formal consent, some discussion—including hearing the patient’s concerns and preferences—is advised. Practices and departments that perform a finite set of “routine” procedures may want to establish a permission policy and protocol for each one, increasing the opportunity for a patient to feel respected and free to choose.

Additional Resources

March 1, 2007
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