Consent Form Debacle by Val Jones MD

Val Jones can be found at getbetterhealth.com and she is great medical blogger.  I have known her for a while and really respect her opinion (and humor).  She allowed me to use this piece because I begged her.   Please visit her site and check her out.

Do We Really Need Another Branch Of Government To Enforce Medical Informed Consent?

Health Leaders Media recently published an article about “the latest idea in healthcare: the informed shared medical decision.”  While this “latest idea” is actually as old as the Hippocratic Oath, the notion that we need to create an extra layer of bureaucracy to enforce it is even more ridiculous. The author argues that physicians and surgeons are recommending too many procedures for their patients, without offering them full disclosure about their non-procedural options. This trend can be easily solved, she says, by blocking patient access to surgical consultants:

“The surgeon isn’t part of the process. Instead, patients would learn from experts—perhaps hired by the health system or the payers—whether they meet indications for the procedure or whether there are feasible alternatives.”

So surgeons familiar with the nuances of an individual’s case, and who perform the procedure themselves, are not to be consulted during the risk/benefit analysis phase of a “shared” decision. Instead, the “real experts” – people hired by insurance companies or the government – should provide information to the patient.

I understand that surgeons and interventionalists have potential financial incentives to perform procedures, but in my experience the fear of complications, poor outcomes, or patient harm is enough to prevent most doctors from performing unnecessary invasive therapies. Not to mention that many of us actually want to do the right thing, and have more than enough patients who clearly qualify for procedures than to try to pressure those who don’t need them into having them done.

And if you think that “experts hired by a health insurance company or government agency” will be more objective in their recommendations, then you’re seriously out of touch. Incentives to block and deny treatments for enhanced profit margins – or to curtail government spending – are stronger than a surgeons’ need to line her pockets. When you take the human element out of shared decision-making, then you lose accountability – people become numbers, and procedures are a cost center. Patients should have the right to look their provider in the eye and receive an explanation as to what their options are, and the risks and benefits of each choice.

I believe in a ground up, not a top down, approach to reducing unnecessary testing and treatment. Physicians and their professional organizations should be actively involved in promoting evidence-based practices that benefit patients and engage them in informed decision making. Such organizations already exist, and I’d like to see their role expand.

The last thing we need is another bureaucratic layer inserted in the physician-patient relationship. Let’s hold each other accountable for doing the right thing, and let the insurance company and government “experts” take on more meaningful jobs in clinical care giving.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Consent Form Debacle by Val Jones MD

  1. Ben
    August 22, 2012 at 10:46 pm

    REGARDING DOUGS QUESTION OF SHORTAGE OF PRIMARY DOCTORS NOT INCREASING PAY.

    I will explain why the supply side is low and the demand is high yet family docs don’t increase pay much.

    One side note is that there has been a moderate increasefor primary care pay while many other specialties have seen a decrease.

    The main reason is price controls. The government has set the fees, and insurance companies follow. When you have price controls then you end up with shortages (ie family doctors).

    The same thing happened when the government tried to “fix” the price of gas in 1973-4 by price controls. The public demanded gas prices be fixed because gas was a “right” just like medical care. What happened was a shortage of gas, despite high demand. The same principle applies to primary care. The government fixes the price, the price is too low, so shortgages result despite demand.

    In plastic surgery the same applies to our emergency cases. Every specialty does what we do for a living during the day, Ortho-hand, derm-skin cancer, hospital clinics-wound, and everyone is a cosmetic surgeon. The millionaire parents of little Suzy demand a plastic surgeon to come to the emergency room for a 1 cm laceration that their insurance will pay $80. Two and a half hours total elapsed time for a wealthy persons insurance to pay you $80, including $300,000 of annual expenses (and the other uninsured trauma cases), and the followup. I have to pay $300 to get a guy to come to fix my copier – and that is during the daytime and scheduled. So of course, the smart docs avoid call, and there is a shortage.

    PRICE CONTROLS = SHORTAGE

  2. rokosz
    August 22, 2012 at 12:40 pm

    @Nagle, exactree. There are bad apples in any profession. a bad doctor (ie a surgeon who is just scalpel-happy) is particularly heinous given the physical harm. But a HC organization that (expects) its public-facing employees to behave badly seems to be the impetus for this need. Nowadays I’m beginning to feel I should put MDs on my (not quite shortest) list of professions that require extreme care when selecting a provider. Why? well, 1 & 2 on the shortest list are Dentists and auto mechanics. Dentists because, personal experience, my mouth is full of mercurial silver – because I had cavities? No (at least not always), because I had selected dentists that at best couldn’t read an x-ray and at worst just needed to line their pockets. I found my current dentist about 9 years ago. After 35 years or so of constant cavities- I’ve never had a cavitie (sp?!!) Yes, one painfully obvious abcess. I dread the day he retires. Auto mechanics same deal.

    How do you know the “specialist” is prescribing the correct remediation? and not a more expensive “billing” item for a simpler issue?

    Just because one is cynical doesn’t mean s/he is incorrect.

    Try this:
    http://www.nytimes.com/2012/08/07/business/hca-discloses-us-inquiry-into-cardiology-services.html

    and perhaps this too:
    http://www.nytimes.com/2012/08/15/business/hca-giant-hospital-chain-creates-a-windfall-for-private-equity.html?_r=1&pagewanted=all

    Interesting the articles both focus on HCA. Dr. Farragos earlier graph of the growth of admins vs. Mds @ facilities was really shocking.

  3. August 22, 2012 at 10:05 am

    Isn’t this what we already have, when flunkies at an insurance co. decide whether you need x treatment?

  4. August 22, 2012 at 8:41 am

    Thank you for posting this, Doug. Now that you’re in VA, we should plan to have lunch sometime. I’d love to introduce you to my practice partners (we have a pay as you go, time-based billing practice). We’re looking for more primary care docs. You’d LOVE it! –V

    • Doug Farrago
      August 22, 2012 at 2:28 pm

      Yes, we will connect soon!

Comments are closed.