Discussion: Michael Klein, MD

I am pleased to note that 93% of respondents opined that the attending should obtain the consent and of that total 57% opined the staff could obtain the consent after the discussion between the attending and the patient. The remaining 36% opined the attending should do both the discussion and the consent. An informed consent involves the legal definition which can be different in the state where you practice and the state where you trained. I encourage you to be familiar with the Civil Code in your state and how it is defined. There are multiple definitions of consent, each with a slightly different spin and components. Dr. Kadan's article1 regarding clinical research is also applicable to elective spinal procedures and requires 1) Information Disclosure 2) Competence 3) Meaningful Informed Consent 4) Comprehension by the patient and 5) Voluntariness. A more general definition requires the discussion be 1) Clear 2) Continuous 3) Coercion-free & 4) Involve competency. This is imperative when English is not the patient's primary language, thus requiring an interpreter. I like Paul Nissell's approach in his article2, “Patient Consent-Decision or Assumption- Valid vs. Informed,” which focuses on the five requirements of a thorough informed consent, 1. The Diagnosis 2. The proposed treatment 3. The attendant risks 4. The benefits of treatment & 5. Alternative treatment options. Consider using A-V aids in the patient's native language and multi-media tools.