Brave New World

Be Careful What You Wish For

History and Future of the Patient Consent Process

Example surgical consent in 1953:

Patient: “My stomach hurts”

Surgeon: “We need to operate”

Patient: “What is wrong with me, doc?”

Surgeon: “Let me worry about that”

[Surgeon exits stage left with God’s speed]

Example surgical consent in 2022:

Patient: “My choledocolithiasis needs surgical attention, provider; after our interview I will decide whether I will ask you to operate. Isn’t that right, honey? [patient looks to wife bearing an iPad replete with browser open to WebMD and WebMonkey survey tool along with being logged into MyAndOnlyMyChart electronic record]”

Surgeon: “[now seated in prostrated stance, chin down, palms up, eyes submissively fixed upward meeting patient’s gaze, as proscribed by section 234223 a.2. of PillarHealth encounter policy] I am so grateful to be considered as a prospective surgeon to assist you with treating your medical problem. I am extremely sorry for the 232 page consent form our administrative assistant’s lead relations liaison assistant’s secretary sent you. Our senior patient relations ombudsman’s associate concierge would be happy to translate any and all of the particulars. It is our great pleasure to deliver you care of the highest order here at PillarHealth. I can only imagine the great suffering you and your family have endured [now checks iPad for exact script wording] these many, uh, 9, uh ,days…”

Patient: “Let’s get on with this. My time and my organs are valuable. I’ve already completed the online history, telehealth exam, AtHome imaging, DrawMeNow blood work and research into MY problem. Incidently, your recommendation of a procalcitonin was both weakly supported by the evidence and costly. I will be deducting points in your evaluation for that.”

Surgeon: “I do sincerely apologize for that misinterpretation of the literature. I will be sure to have my assistant’s liaison to the concierge of financial oversight immediately remove that charge from your account”

Patient’s wife: “I also expect to be scrubbed into the procedure as is my option according to the accountable care act ammendent of 2018.”

Surgeon: “Naturally, Mrs. [examine iPad EMR], uh, Smith”

[40 minutes of discussions follow re: the impact of the proposed GB surgery will have on the Smith’s pets and upcoming trips to Gary, Indiana and South Bend and the emotional consequences for their two 3-year old twin granddaughters who are dealing with PTSD of childhood due to Daycare-Missed-Snack syndrome (DMSS)]

Patient: “Thank you for your time, provider. We will get back to you.”

Surgeon: “ Please consider giving me 10’s in all categories on the WebMonkey survey our Associate Accountable Care Organizational Survey Specialist will send you!”

[surgeon departs according to PillarHealth patient-family-centered-subservience policy with 45 degree genuflected torso, 5 degree head bowing and appropriate extreme deferential posturing]