The article discusses physicians' role in obtaining a patient's informed consent before major medical procedures or experiments. The discussion is informed by the Pennsylvania Supreme Court's decision in a case between Dr. Steven Toms and Ms. Megan Shinal. While Toms performed a total resection of a recurrent craniopharyngioma on Shinal, he accidentally perforated her carotid artery, causing a permanent severe neurologic injury on Shinal. Shinal sued, saying that the doctor did not fully inform her of the possible consequences of the procedure or the existence of a less-risky procedure. Documents showed that Tom's physician assistant had shared that information with Shinal. The only missing detail was the difference in risk between the two procedures. On a majority decision, the state Supreme Court ruled that Tom's duty was to educate the patient on all the risks and obtain her consent. According to the ruling, that duty cannot be delegated to other Tom's staff members. Lynch & Feldman (2018) argue that whereas the buck of obtaining the consent stops with the physician, he should be legally and ethically allowed to delegate that duty to focus more on the stuff that only he can do.
I agree with the authors' position on this issue. Due to the number of people doctors have to see each day, they do not have the time to explain everything to the patients. However, they can introduce the suggested treatment methods at a high level to the patients and let their assistants do the work. The key to success here, and Lynch and Feldman (2018) point out, is to ensure that the assistants have the requisite training, expertise, tools, and time necessary to discharge the duties efficiently. It is upon the doctor to ensure that the process works by performing occasional audits and confirming that patients are fully informed before the procedure. The approach's importance is to make sure that the doctor does not waste too much time performing duties that others can perform while abdicating those that only they have the skills to perform.
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In conclusion, the Pennsylvania Supreme Court's precedent is a dangerous one bound to create inefficiency in the medical field. Physicians are now more worried about the consent process than the procedure itself. While the physician should be held liable for anything that goes wrong in the consent or the operation process, it is unnecessary to force him to handle duties he can delegate. As Lynch and Feldman (2018) posit, making the "treating physician personally provide all consent-related disclosures is an anachronism in a team-based health care system" (p. 2437). The doctor hires a team to help him in duties such as these as he focuses on the duties that only he can perform.
References
Lynch, H. F., Joffe, S., & Feldman, E. A. (2018). Informed consent and the role of the treating
physician. New England Journal of Medicine , 378 (25), 2433-2438.
