Successful Training in Gastrointestinal Endoscopy. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: John Wiley & Sons Limited
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Жанр произведения: Медицина
Год издания: 0
isbn: 9781119529682
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a patient–doctor relationship that empowers and educates the patient to understand the indication for the procedure and reviews the necessary elements of informed consent. Finally, a focused history and physical exam provides the physician important preoperative risk assessment and reassures the patient that the physician has properly considered their individual health prior to the procedure.

      Informed consent

Indication for procedure The indication is specified, and if a nonstandard indication, the reason is documented
Informed consent Proper informed consent documenting “PARQ” is documented
Focused history and physical exam Document any cardiovascular disease, medications, allergies, vital signs, heart and lung exam, and airway assessment
Preprocedure risk assessment Document ASA and/or Mallampati score
Appropriate use of prophylactic antibiotics As per published guidelines
Management of anticoagulants and antiplatelet agents Plan as to whether and when to stop them and when to resume is documented
Sedation plan Specify the depth of sedation planned: minimal, moderate, deep, or general anesthesia
Team pause Ensure that the proper patient is undergoing the proper procedure

      The process of informed consent requires a thoughtful exchange of seven essential elements between the physician and patient. The consent form should be timed and dated and, if possible, witnessed by a third party.

      There are seven elements that require discussion in nontechnical terms and should be appropriately documented. These include the following:

      1 Nature of procedure.

      2 Benefits.

      3 Material risks and complications of the procedure, including their likely incidences and severity.

      4 Alternatives (including nontreatment).

      5 Limitations of procedure.

      6 Conflict of interest/research evaluation: A physician who has either financial or research gain in enrolling a patient into a specific study or medication must be direct about these affiliations.

      7 Opportunity given for patient to ask questions.

      Exceptions to informed consent

      In a few specific circumstances, a physician can bypass the need to acquire informed consent. Several important exemptions to informed consent include the following [3, 4]:

      1 Emergency waiver: The patient's critical condition incapacitates them from providing informed consent, and delay in performing the procedure can result in unnecessary harm to the patient.

      2 Waiver of self‐determination: A patient waives his/her right of informed disclosure and assigns his/her physician the right for decision‐making.

      3 Legal mandate: A judge or court orders a necessary medical therapy for a patient without their consent.

      4 Incompetence: A patient cannot make a decision and thus this responsibility is given to an assigned third party (legal guardian).

      5 Therapeutic privilege: A physician can withhold information regarding the procedure because of perceived harm to the patient. This is a difficult exception and one that can be perceived as an excuse for not informing the patient. Unless there is a clear and compelling evidence of psychological vulnerability, it is best to avoid use of this exception.

      Informed refusal

      Patients who refuse a procedure must do so in a well‐informed way. The physician should document that she/he has explained the purpose of the examination and the consequences of deferring the procedure.

      Lack of informed consent

      If there is no consent or the procedure goes beyond the scope of obtained consent, a charge of battery could be brought upon the physician. Unlike medical malpractice suits, which are a civil offense retributed monetarily, a charge of battery is a criminal allegation. Therefore, when obtaining consent, it may be reasonable to expand the extent of the consent to include foreseeable complications (i.e., surgery in the setting of perforation or blood transfusion in the setting of bleeding). Most malpractice insurances do not cover battery and a physician can be held personally liable. Additionally, a charge of battery can result in restriction of hospital privileges [10].

      Documentation

      Preoperative clinical assessment: focused history and physical exam