The informed consent document, carefully filed in the patient’s medical records, has only legal value. It is the process of obtaining the informed consent that is medically valuable. Obtaining an informed consent should be seen as a quality control review of the patient’s care. A proper informed consent must deal with the key elements in medical decision making: the patient’s physical condition, the patient’s subjective complaints and expectations, and the appropriateness of a proposed treatment.

Few patients are sophisticated medical care consumers. They lack technical knowledge about medicine, and it is difficult for them to be objective about their health. Despite a physician’s best efforts, questioning about medical history sometimes leads to an incorrect assessment of the patient’s condition. This may arise because the patient misstates the severity of the condition, either denying or overstating its seriousness, or because the physician unconsciously directs the patient’s answers toward the medical conditions that the physician is most interested in. Irrespective of how these misunderstandings arise, they dangerously distort the factual basis for medical decision making.

A careful discussion of the risks of the proposed treatment may cause the patient to reconsider the actual severity of his or her problem. The physician must be open to indications that the patient is growing uncomfortable about undergoing the proposed treatment. Synergistic misunderstandings can arise when the physician overestimates the severity of the patient’s problem and recommends a major intervention. The patient then believes that the problem must be serious because the physician has recommended such a major treatment. Unless the physician carefully questions the patient after the treatment has been proposed but before it is carried out, the patient’s belief that he or she must be sick because the physician wants to treat him or her as sick will not surface until the patient is injured.