Informed Consent Versus Understood Consent

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We need to move from informed consent to understood consent and figure out ways to prove that patients understand what the doctor said, wrote, or communicated by some other means.

If you have had surgery or any other kind of procedure lately, you signed an informed consent to surgery or treatment. The problem is that you probably did not understand it and most likely forget what you signed 10 minutes after doing so.

When it comes to improving patient understanding of medical information, there are lots of roadblocks:

1. The information is not standardized or delivered in a uniform way by doctors or other medical staff.

2. The language is difficult to understand.

3. Patients are not emotionally prepared to make a decision. How much can you really process after you've been told you have cancer?

4. Patients are asked to sign forms under duress, like just before they go to surgery.

5. Patients learn different ways. Some are visual, some are verbal.


6. Patients often want to share the decision with other family members and can't when the form is staring them in the face.

7. There is little or no opportunity to get more information to make the decision at the point of care.

8. Almost every consumer facing industry uses marketing and sales techniques based on customer relationship management. Look at Amazon or Zappos.

9. There are few ways to include video, graphics, or personal websites to education and inform.

10. There are few ways to engage patients after their treatments to assure medically appropriate follow up, particularly when they move or relocate. But, if I have your cell number, that is probably more valuable than your Social Security Number when it comes to tracking you.

We need to move from informed consent to understood consent and figure out ways to prove that you understood what the doctor said, wrote, communicated by email or text, or showed you some other way. Otherwise, we are just winking at each other pretending that what we are doing now is effective. It's not.