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The Surgical Consent Form

Surgical consent forms should include the general risks of surgery and the specific risks of the proposed treatment. The form should mention that there is always a small chance of death and brain injury from anesthesia. The consent form should present an accurate picture of the risks of the procedure. While there is no foolproof way to determine which risks to list, a starting point is the risks that the surgeon would worry about if undergoing the proposed operation. In almost all cases, a specific risk should be that the surgery will not cure the underlying problem: vasectomies fail, laminectomies sometimes make the pain worse, and facelifts sometimes fall. There should be no guarantees, either implicit or explicit.

Most surgical consent forms include a brief note on the risks of anesthesia. Ideally the consent form will separate the consent to surgery from the consent to anesthesia. The risks will be separately delineated, as will possible alternatives. The anesthesiologist should be named, just as the surgeon is named. Since patients expected anesthesia to be delivered by an anesthesiologist, there should be specific consent for a CRNA to deliver or monitor the anesthesia. This should include information about the limited training of a CRNA as compared with an anesthesiologist and the person with the legal liability for supervising the CRNA. Such information is necessary for a patient to make an informed consent. It will also prevent misunderstandings with the surgeon in situations where there is not a supervising anesthesiologist.

The advent of new procedures such as laser surgery and endoscopic gall bladder removal has raised new issues for informed consent. The first problem is whether patients are properly informed when they are undergoing what should be considered experimental treatments. The explosive growth of laparoscopic cholecystectomy occurred before the risks were well understood.[233] Many patients did not appreciate the experimental nature of the procedure. During this growth phase, death was more common with endoscopic procedures than in open procedures. This was not explained to the patients undergoing the procedure, creating a classic failure of informed consent. Patients are also entitled to information about the surgeon's experience with the procedure. This is especially relevant if the surgeon does not meet the generally accepted standards for training and experience with the procedure.[234] (SAGES 1991).

[233]Cole HM: Diagnostic and therapeutic technology assessment (DATTA). JAMA 1991; 265:1585-87.


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