Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, November 12, 2007

Now This Takes Balls

I saw a patient today who had a History and Physical form she needed completed for (non-cosmetic) plastic surgery. The procedure was to be done in an outpatient facility, whose form was obviously being used for this purpose. It was a fairly standard, basic H&P form, until I got to the very bottom where it said this:
Surgery and alternative treatments were discussed with the patient. Complications of surgery and expected outcomes were also discussed.
WTF? Although it's just a little line of fine print at the bottom of the form (above the line for my signature) it states in essence that I am the one who has obtained the patient's informed consent for the procedure.


Has anyone else noticed how lazy certain surgeons have become? I don't mind looking patients over for a podiatrist or an ophthalmologist (even though the latter did go to medical school once upon a time) but orthopods, urologists and plastic surgeons ought to be able to do an H&P. Failing that, if they want documentation from someone who actually deals with sick people on a regular basis that their patient is in good enough shape to survive whatever it is they want to do for them, ok I guess. But don't try slipping that little line in there, effectively leaving my ass hanging in the breeze when the lawyers come calling about informed consent.

By the way, before I signed the form I crossed out the offending line, initialed it, and wrote in:
Informed consent to be obtained by the primary surgeon.
So there!


At Mon Nov 12, 09:42:00 PM, Blogger MedStudentGod (MSG) said...

Completely correct. How are you going to discuss alternative options for a procedure you don't perform? WTF is that? Good call.

And I hope TMH is doing well.

At Mon Nov 12, 10:34:00 PM, Blogger rlbates said...

If the plastic surgeon wanted to know about the patient's other diseases (for example heart disease) and whether she was able to withstand the stresses of surgery, then the PS should have asked that of you. I am a plastic surgeon and I agree with you, we should do our own H&P's. Most outpt H&P forms are very limited anyway, no complete ROS, etc.

And I really agree with you crossing out the line about consent. Leave that to the surgeon. We should be responsible for that.

At Mon Nov 12, 10:34:00 PM, Anonymous Anonymous said...

Is the H&P form a standard one for the surgery center or is it specific to the surgeon? I know that my place now has more info than just the H&P.

And we do appreciate a PCP giving the patient a once-over to make sure that everything is spiffy. There's nothing that I hate worse than showing up at the OR to hear from the GasMan that they think that the patient's primary needs to check out XYZ before he can have his nerve release.

And don't worry -- I consent my own patients. ;-)

At Mon Nov 12, 10:54:00 PM, Blogger Dreaming again said...


I am behind you 100% as a patient. I do not want the doctor NOT doing the procedure going over with me what's happening. It's not reassuring to me when some other doctor talks to me about it.

At Mon Nov 12, 11:48:00 PM, Blogger Keagirl said...

WTF???? I do all my own H&Ps and obtain all my own consents. It's absolutely wrong to have anyone else beside the surgeon obtain consent for a procedure she/he is going to do. I can't believe you even agreed to fill out the H&P form for the plastique guy. (talk about chutzpah!)

I will only refer a patient back to their PCP or cardiologist if there are doubts about their medical status (cardiac issues, glucose over 300 or dangerously high BPs) before general anesthesia. Otherwise I do all the post op management myself, including medical ones, unless the PCP really wants to get involved.

This type of behavior gives a very bad name to dedicated surgeons out there. Yes, we do exist, and we are not all like that!!!

At Tue Nov 13, 08:44:00 AM, Blogger tk said...

Good for you! I've done that myself in other circumstances . . .

In my case, I added the line "present but not in agreement" before signing an IEP (and I later requested a re-eval).

At Tue Nov 13, 09:06:00 AM, Anonymous Anonymous said...

You are absolutely correct about the informed consent issue. As to pre-op H&P's... Many of the orthopods and ophthalmologists in our area are doing them or should I say their PA's are doing them? Who would you prefer the patient have for that pre-op clearance? You or a PA?

At Tue Nov 13, 09:10:00 AM, Blogger Lynn Price said...

Good on ya, Dino. What's scary is that the patient doesn't know his surgeon is failing to do his due diligence.

At Tue Nov 13, 09:46:00 AM, Anonymous Anonymous said...

do you really think it was intentional or just on oversight by some clerk who faxed or gave the patient the standard h&p form they use?
obviously no one thinks you should get informed consent, i'm just wondering why everyone is so quick to shout down the surgeon.

At Tue Nov 13, 10:34:00 AM, Anonymous Anonymous said...

Good for you.

Just another example of doctors abdicating their responsibility.

I just saw a patient this morning who had seen a gastroenterologist and had a colonoscopy two months ago. He had a suspicious lesion in the cecum and surgery was recommended. The family told me that they were waiting for a referral from me.

The other thing I get upset about is when patients refer themselves to other doctors and those offices call me for a list of the medications that the patient is on.

At Tue Nov 13, 06:27:00 PM, Blogger Dr. Val said...

What if there were a surgical complication? Would you have to share liability had you unwittingly signed that YOU had obtained consent? That makes me very nervous...

And yes, it could have been a clerical error... but if not, how scary!

At Wed Nov 14, 07:03:00 AM, Blogger girlvet said...

That is just unbelieveable! I wonder how many people, in a hurry never read the fine print?

At Wed Nov 14, 08:31:00 AM, Blogger tk said...

It's scary even if it is a clerical error . . .

At Thu Nov 15, 09:56:00 AM, Anonymous Anonymous said...

i get it a little bit.
you are worried because usually you don't read the forms you are signing.
don't fill out their form then. just send your own dictation or last note from clinic. i am sure that would be acceptable for their purposes.
i really don't think it is something to get upset over. it is a result of all the jcaho crap. you have no obligation to fill out the form, just tell the surgery facility no and send them your note. if you even want to, or tell them to have the surgeon fill it out themselves.

At Thu Nov 15, 04:14:00 PM, Blogger Sid Schwab said...

I'd guess -- I'd hope -- that it was some sort of generic form and the presence of the line was not really an implication that you were to be the consent-getter. An un-noticed thing by the surgeon. On the other hand, I don't think it's beyond possibility. If so, you were more than justified. Some surgeons completely abdicate. Along those lines, you might find this amusing. (Contains a nasty word at the end.)

At Tue Nov 27, 01:23:00 PM, Blogger A Girl said...

Excellent post. I could have written it. WTF is right.

I've gotten the same treatment from surgeons who are going to do procedures on AIDS patients, and because I am the "AIDS doctor", they expect me to get full consent for whatever the hell they're about to do.....which half the time, I don't even know. And good luck trying to talk to one of them about it (civilly, anyway).


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