Psychiatry Residents don’t volunteer information for informed consent

We can easily assume that psychiatrists in general have the same habits as the residents talked about in the article below as many of our lived experiences suggest. When we are young, desperate and naive, how many of us think to ask the pertinent questions? And then when we are thoroughly brainwashed to believe meds are the only way, how many of us really want to know the risks? If we have no alternatives, as we are led to believe, doesn’t it feel safer to just not know? These “passive” doctors are taking the easy way out to our great expense.

That these doctors “meet the criteria of informed consent” by what they were willing to answer gives me no comfort. Unfortunately most of us still blindly trust our doctors and do not ask questions. Also in my experience even when I asked questions responses rarely covered all the bases. Doctors, in general don’t even know enough to give proper information as they get most of the information from the PDR and drug reps–both sources incomplete and often misleading. So meeting the current “criteria” for informed consent, whatever that might be, is unlikely to be sufficient anyway for real informed consent which should include alternatives.

Most doctors simply do not believe in alternatives and offering alternatives is not part of the generally accepted criteria among doctors for informed consent.

Of course when we come to learn by our own grave pharmaceutical injuries what informed consent might actually look like had we been given it and we start speaking up, the medical establishment denies our experience…so we really have a long way to go.

Below the article I am speaking about:

Reuters Health

Thursday, May 17, 2007

NEW YORK (Reuters Health) – Psychiatry residents tend to take a “passive approach to informed consent discussions” when presented with common clinical scenarios, according to a report in the Journal of Clinical Psychiatry.

“Since it appeared that residents in our study failed to actively bring up the topics necessary to obtain informed consent, educating them that they must do so may remedy the problem,” Dr. Bret R. Rutherford from Columbia University, New York told Reuters Health.

Informed consent refers to the communication between a physician and patient in which the physician discloses enough information so the patient understands the treatment or procedure he or she is agreeing to have – or not to have. The physician will typically provide the diagnosis, the purpose of treatment, the risks and benefits, and other relevant information. In turn, the patient should have the opportunity to ask questions.

Rutherford and colleagues investigated the informed consent practices of 108 psychiatry residents by assessing their responses to clinical vignettes describing three hypothetical patients with major depression, borderline personality, or neurotic character traits.

Only 8 of 324 completed vignette responses (3 percent) met the criteria for adequate informed consent, the authors report, and only 3 of 324 met criteria for optimal informed consent.

When revised criteria, which counted answering patients’ questions, were used, more than half the vignettes met the criteria for adequate informed consent, and one third of the residents met the revised criteria for all vignettes.

“Initially, we were surprised that so few residents met our criteria for informed consent,” Rutherford continued. However, when the data were reanalyzed to include what residents were willing to answer, the majority did meet criteria for informed consent.

“That told us the problem was not that the residents lacked knowledge about the elements of informed consent, but they failed to actively…bring up these issues with their patients.”

The results “suggest that changing residents’ passive approach to informed consent discussions might have a large impact,” the investigators write.

“Residents (and, apparently, all other physicians, given similar findings by other researchers) need to see it as incumbent upon them to proactively bring up informed consent issues with their patients and not simply answer the patients’ questions if they ask,” Rutherford concluded.

SOURCE: Journal of Clinical Psychiatry, April 2007.

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About Monica Cassani

Author/Editor Beyond Meds: Everything Matters