Eyeworld

EW NEWS & OPINION 28 December 2017 YES connect by Liz Hillman EyeWorld Staff Writer if this is really about minimizing the risk of being sued, patients appreci- ate physicians who take extra time to talk with them," said Dr. Wil- liams, who is chairman of the Oph- thalmic Mutual Insurance Company (OMIC) Board of Directors. "Early in your career, if you take the time to work on developing that skill for providing informed consent, it's something that will serve you well throughout your career." Who, what, where, and when of informed consent Bryan S. Lee, MD, JD, Altos Eye Physicians, Los Altos, California, echoed similar thoughts to those of Dr. Williams, saying that informed consent is more than a declaration on a document. "It's the entire process of the conversation you have with patients and answering their questions as well," Dr. Lee said. "That is the foundation of obtaining consent and making sure they understand the risks, benefits, and alternatives to surgery." It's also a process that Dr. Wil- liams said is best left to the physi- cian, rather than a technician, nurse, scheduler, or other staff member. "I think that when you're proposing an operation on an indi- vidual, it is the surgeon's responsi- bility to make sure that there are no questions. It's the surgeon's respon- sibility to have explained the process and the implications of the surgery," Dr. Williams said. "That may be a bit old fashioned, but if it comes before a jury, that's what juries are going to expect also." Courts consider informed consent the doctor's duty as well. In June 2017, the Pennsylvania Su- preme Court in Shinal v. Toms ruled that it is the physician's responsibil- ity—not that of any member of the staff—to obtain informed consent from patients. The justices stated: "This Court has held that the duty to obtain informed consent belongs solely to the physician and that is non-delegable." 2 In addition to a verbal conver- sation, paperwork informing the pa- tient of risks, benefits, and possible alternatives should be issued. Hans Experts discuss the importance of obtaining truly informed consent "I nformed consent is a process—it's not a form," said George Williams, MD, Oak- land University Wil- liam Beaumont School of Medicine, Royal Oak, Michigan. From a medicolegal standpoint, informed consent is a process that's important for the physician to ade- quately address with the patient as it could make or break a lawsuit. A lack of informed consent accounted for nearly 50% of malpractice alle- gations in a study published in the journal Cornea about litigation out- comes in refractive surgery cases. 1 Young eye surgeons have a particular advantage early in their career to focus on the informed consent process. Why? Because they have time, Dr. Williams said. "[Young eye surgeons] are going to come out, start slow, so if any- thing, they have the time to develop these skills, to develop rapport, and Informed consent: More than just getting patients to sign a piece of paper T he landscape of anterior segment sur- gery is changing rapidly. As surgeons, we have an ever-expanding range of treatment options to offer our patients, and explaining the many choices to our patients is becoming more complex. The process of informed consent can be time-consuming, and we may be looking for ways to utilize support staff or use pre-recorded videos or animations to convey some of the repeti- tive aspects of these interactions. In some situations, we may be tempted to leave out certain information if we think it may confuse our patients. But what is essen- tial for patients to know? In order to truly give informed consent, should patients be given consent forms ahead of time so they have a chance to review them in detail and formulate questions? What about off-label procedures? What do we need to tell our patients when we plan to use techniques or devices for a non-FDA approved indication? This month, we explore issues related to informed consent for femtosecond laser- assisted cataract surgery, corneal cross- linking, and off-label surgical techniques for scleral fixation of intraocular lenses. We asked George Williams, MD, Bryan Lee, MD, and Hans Bruhn for their recommenda- tions on how to make the informed consent process for these surgeries more robust. Naveen Rao, MD YES connect co-editor continued on page 30

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