Friday, March 18, 2011

Informed Consent

"Sir, your mother is very sick. Her Troponins came back elevated. The question is do we need to admit her to the ICU where she may need pressors or ..."

The son turned and looked at me. I could already tell that he was lost.
The admitting doctor had just walked into the room and after her assessment, had let loose...

He didn't understand a word beyond "your mother is very sick".
He managed to nod at the 'appropriate' times; while looking politely dumb otherwise.

The admitting doctor carried on and I was called away to another patient who was having trouble with their heart rate.

When I managed to figure out what was going on with my other patient and had intervened to stabilize the problem, Ms. "elevated troponins" was still 'stable' and was being admitted to the ICU with orders for "pressors" among a myriad others.

As I walked into the room, with bags of meds, tubing and IV pumps; the son was sitting at the bedside, caressing his mother's hand while talking in a whisper to her ear.

While I was setting up the IV pumps and meds, I made small talk with Mr. Smith, the son. Are you the oldest son? How many siblings do you have? etc.
"Mr. Smith, I know you just had a serious discussion with the Doctor about your mother's condition. Do you have any questions?"

Scarcely had the words left my mouth when out poured a torrent of questions!!! It was like the Johnstown flood!

Why is she going to the ICU?
Is my mother dying?
What the **** is pressors?
Why are her lab results abnormal? What the hell does that mean?
Why is she so 'sleepy'?

So on and so forth...

I did my best to answer his questions, in layman terms as much as I could. "Pressor is just a fancy word for medicine that helps raise blood pressure. As you can see on the monitor, your mother's blood pressure is too low. If it stays low, her brain and heart and kidneys won't get enough food and oxygen and that'll cause damage." etc.

I ended up spending a good bit of time explaining things to Mr. Smith - and in the end, I had the admitting doc paged back into the room [while I was present] to make sure he had his questions answered.

Mr. Smith wasn't an idiot - he was an engineer who managed a successful business.
He was just clueless about "medical issues". Just like John Q Public with no medical background.

All he knew and cared about was the fact that his mother was sick, literally comatose ... and that's it.

Walking into this room and talking about "ICU" and "pressors" - how the hell is he supposed to understand any of this? Even with a 'medical background' such issues are difficult to comprehend.
Now put yourself in this man's shoes - we're talking about your loved one here. If someone wearing hospital scrubs or a white-coat walks in starts mouthing of "ICU", "pressors", "heroic measures if her heart stops" - what would you think? How would you feel?

Yes, there are mitigating circumstances. "Look, at her condition now, she will definitely die. The procedure we're looking to perform has a chance of success but it also carries the risk that she'll die from the procedure. What are you're wishes?"

Ms. Smith's case certainly wasn't that dire. Critical, yes. Unstable, no.

But even if she was - doesn't the family/kin/PoA deserve that little bit of knowledge? In PLAIN TERMS that they can understand?
Instead of saying "we need to put her on pressors and admit her to the ICU" can we not say "We need to put her on medication to help maintain a good blood pressure that will help her heart and we need to admit her to the ICU so that she'll be more closely monitored" ??

What does that take - an extra 30 seconds of speech?

It just really makes me wonder - how "informed", is 'informed consent'?