Friday, 2 August 2013

A momentous day, and a question of Consent

I can’t start this posting without first mentioning my huge pride in my little sister, Becca.
On Wednesday, Becca is due to marry Ron, a wonderful man who everyone in the family adores. Now you might imagine that for the last weeks leading up to the wedding she has been focussing on all the planning for such a momentous event. In fact, she has been sitting university exams in architecture, and excelling: scoring in the top ranks of her year-group including a recent 100%. And as if that’s not enough, she decided to make her own wedding dress, because life just isn’t sufficiently busy.
But her trailblazing isn’t new. Becca was the first member of our family to make aliyah, about 5 years ago, and being our here without family, and initially without a job, had the most challenging time of it. She showed it could be done, which was no small part in encouraging the rest of us to give it a go.

I wanted to find a link to the other thing I’ve been thinking about, but I can’t so apologies for the clash in theme.

The question I had was why is there such a difference in attitudes in consent in the UK vs. Israel?

I first noticed this when I opened a bank account. In Jerusalem, I was asked to sign about 13 pages of forms, each one with dense text. When I asked what I was signing, or for an English copy, I never got a proper answer, except that it is necessary to get an account. I know that in the UK we do also sign saying “we have read the terms and conditions”, but that seems less frightening than signing 13 pages individually, each confirming that I giving away some other right.

This would all be no more than an intellectual curiosity, except that I’ve found it’s started to affect how I explain anaesthesia to patients at work.

So compare the way one surgeon tried to consent my patient, in the theatres reception:
“You want anaesthesia? Please sign here.”
(handing patient a page of dense A4 text listing all the risks of GA, including everything from pain to Malignant Hyperthermia and Death) the way the nice young British immigrant doctor (Yours Truly) put it:
“Now to explain what will happen in the OR. (explanation of arriving, getting oxygen mask, IV line and drugs to go to sleep, followed by wake up in the Recovery Ward).

“I have here the anaesthetic consent form. It lists all the very rare things that can occasionally happen under GA. I know it may sound frightening but anaesthesia is extremely safe nowadays.

“If after the operation you feel pain or nausea please let us know and we will give you extra medicines to help with that. Other than that, the much rarer things that occasionally happen in anaesthesia are:
Damage to teeth
Aspiration of vomit
Damage to Lungs;
Allergies to medication
One in several thousand remember their surgery despite GA
One in 250,000 don’t wake up from anaesthesia, which is extremely rare.

Do you have any questions or anything I can explain better?
If you’re happy to go ahead, would you mind signing here and dating here.”

By the end of this, the patient is starting at my wide-eyed (literally. Do you know that people’s eyes genuinely do go wide when they are afraid?)

They all sign, but I never feel that I have eased their medical journey.

I have tried different wording; being humorous; likening the odds to crossing the street (which is a bit of a lie, I have no idea what the one-off risk of crossing a road, but I suspect it is actually less than 1:250,000). None of this works for me. They all seem petrified.

Is it a kindness to put them through this? And will it ultimately make any difference? After all, they are signing the same document that includes these risks and more. In other words, can ignorance be bliss?

I will keep experimenting with other ways of saying the same thing, and who knows, maybe some day I’ll find the magic formulae for an informed, confident and happy patient.