No doctor can treat a patient without his permission, which is why a patient needs to give his consent to the doctor, before treatment starts. In the early part of the twentieth century, the law also recognized that the purpose of obtaining a patients consent, was also to ensure that decisions about medical treatment were consistent with patients wishes.
"Consent" became informed consent as a result of a landmark case in 1957 in the USA. The verdict in this case declared that doctors have a duty to disclose "any facts which are necessary to form the basis of an intelligent consent by the patient to proposed treatment." These necessary facts include information about risks and benefits of the proposed treatment, as well as existing alternatives. Only if the patient has had the opportunity to evaluate the available options and to weigh their attendant risks and benefits, the court held, can he make an informed and independent choice.
Informed consent is required before surgery, before many diagnostic and therapeutic treatments and before a patient participates in any clinical study or research. A signed consent form stands as evidence that a patient has been informed about, and has given permission for, the treatment described on the form. Consent forms protect the rights of the patient, not those of the doctors, as is often believed , since by signing a consent form a patient does not waive the right to sue a doctor hospital/clinic for malpractice.
For a patient to give, and a doctor to receive, properly informed consent, several requirements must be met:
As a patient, you need to make sure your doctor covers the following five areas when getting your informed consent.
- The doctor must give the patient all relevant information about the nature and purpose of the procedure, along with its risks and benefits, and any alternatives (including the alternative of no treatment,) Although patients cannot expect to be told everything about the natural history of their disease (all the possible complications and remote risks involved in all alternative treatments), they are entitled to the disclosure of all "material" information. To define the term "material," courts so far have used a "reasonable patient" standard, instructing doctors to give such information as a reasonable person in the patients position would want to have. Such an option clearly leaves a great deal to the doctors judgment. Of late, a new standard seems to be evolving in which material information is defined as the information that a reasonable patient, in these circumstances, would want to know.
- The patient must understand the information, whether it is given orally or written on a consent form.
- The patients consent must be given voluntarily, without coercion or undue influence from health care personnel or others.
- The patient must be mentally competent to give consent.
There are no guaranteed outcomes in medicine, but informed consent enables YOU to make a rational decision about your treatment and also promotes greater understanding between you and your doctor. It is your responsibility to read each and every word of the document, because, once you sign it, you acknowledge that you understand everything about the procedure(s) and the potential problems that may arise.
- Details of the medical treatment proposed.
- The benefits.
- The risks.
- The alternatives.
- The written documentation.
With informed consent:
A good doctor will guide you --- you should have enough trust in your doctor to be confident that he will not let you make a wrong decision. However, the final responsibility is always yours - make sure you are thoroughly and properly informed, before giving your consent!
- You cannot demand services that are beyond what are considered acceptable medical practice or that violate professional ethics.
- You must recognize that you may be faced with some uncertainties or unpleasantness.
- You should, if competent, be responsible for your choices. Dont have others make decisions for you.
The pertinent question in this context would be: What can you do to keep your medical expenses down? The sanest advise, of course, would be to keep yourself healthy, so that you never need to go to a doctor in the first place! Traditional Indian wisdom is replete with simple but extremely useful therapies such as yoga, meditation and nature therapy, which can help you keep the doctor away far more efficiently than an apple a day can!
Nevertheless, if you do need medical care, there is quite a lot you can do to make sure your bills do not become astronomical -- following the guidelines in this book can help considerably! Some other useful tips are as follows:
Sometimes, hospital bills can be monumental, and they need to be carefully analyzed to spot the errors! Do not assume that just because the bill has been generated on a computer it is bound to be accurate. It is always worthwhile bearing in mind that billing errors are amazingly common, and you need to look out for them actively! Remember that its your precious money and you cannot afford to waste it! You may need to shop around to get a realistic estimate of treatment costs. Medical charges vary widely, and dont automatically assume that the more expensive a doctor is, the better he is !
- Become an intelligent, informed patient and ask all the relevant questions to make sure that the medical procedures that you are required to undertake are really necessary.
- Take out a medical insurance policy when you are healthy -- this precaution can be very helpful in case you do fall ill.
- Do insist on receipts whenever you pay your medical bills. Insist on an itemized bill, so you know exactly what you are being charged for. Scrutinize the bill carefully, to ensure it is accurate.
It would be prudent on your part to discuss your financial concerns with your doctor! Many doctors can and do reduce their fees for patients who face problems with regard to payments. Also, remember that you will get exactly the same quality of medical care in a first class deluxe room in a private hospital, as you will in the general ward, but you will end up paying about ten times more in the former case! Dont forget that the government does provide highly subsidized medical care through its vast network of hospitals. While the queues are long and the wait can be interminable, the quality of medical care is usually very good, and, at that price, its a fantastic bargain!