Medicolegal Considerations in Surgical Procedures (PDF)

Medicolegal Considerations in Surgical Procedures NICHOLAS R. GREEN, OD, FAAO Medical Decision-Making Models Conventional Medical Model ◦ The provider decides on the appropriate care ◦ Patient’s trust and confidence in the provider replaces need for informed consent Conventional Informed Consent M...

Medicolegal Considerations in Surgical Procedures NICHOLAS R. GREEN, OD, FAAO Medical Decision-Making Models Conventional Medical Model ◦ The provider decides on the appropriate care ◦ Patient’s trust and confidence in the provider replaces need for informed consent Conventional Informed Consent Medical Model ◦ The provider decides what care to provide with the implied or express consent of the patient Collaboration Model ◦ The provider and patient work together to make a joint decision about the appropriate care Patient Choice Model ◦ The patient decides the appropriate care with the advice of the provider Standard of Care A doctor is expected to utilize the same degree of skill and knowledge that a reasonable and similar practitioner would have used under the same or similar circumstances May also be defined from the patient’s perspective (i.e. what would a reasonable patient want to be informed about concerning their care) Some standards are well-defined, others have much more subjectivity Malpractice and Medical Battery Malpractice ◦ Professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of care in the medical community and causes injury or death to the patient Medical Battery ◦ Defined as an act by a healthcare professional done intentionally and without consent that causes offensive or harmful contact Negligence Four Elements: ◦ A duty was owed ◦ A duty was breached ◦ The breach caused injury or death ◦ The act or omission deviated from accepted standards of care For surgeons accused of negligence, this is typically due to: ◦ Failure to disclose risks of a proposed procedures ◦ Failure to disclose alternatives to a proposed procedure ◦ Failure to disclose complications or abnormalities arising from the procedure Informed Consent The process of educating a patient or their representative about a procedure and obtaining their permission Evolved from the recognition of an individual’s right to bodily autonomy Protects healthcare providers from some claims of medical battery or negligent nondisclosure, but not outright malpractice Can be given or revoked by the patient or their representative at any time Two Types: ◦ Expressed ◦ Implied Components of an Informed Consent Includes: Must be explained in terms the patient or ◦ Diagnosis their representative can understand ◦ Explanation of what the procedure is and May include explanations of commonly what will be done asked questions and/or discussion of ◦ Expected Outcomes financial obligations ◦ Risks, benefits, and alternatives ◦ Discussion of possible complications, Written and signed informed consent are why it should be done, and other strongly preferred, except in rare cases treatments that can be done instead ◦ Sometimes abbreviated R/B/A Copies of the signed form should be given ◦ Prognosis with and without treatment to the patient or their representative ◦ Conflicts of interest of the healthcare provider If incomplete, this opens the healthcare provider to liability Example Informed Consent Form Procedure Report Serves as the official record of the procedure Should include the following information: ◦ Discussion of risks, benefits, and alternatives ◦ Signed informed consent form or a record of verbal consent ◦ Materials used ◦ Specific description of the procedure ◦ Complications, if they occurred ◦ Post-operative plan Clinical Pearls “Underpromise and overdeliver” Written and signed informed consent forms should be used for any procedures beyond what is offered in a normal eye exam Verbal consents need careful documentation in the patient’s chart Consent can be revoked at any time Questions?