Core value: Consent

Drink this. You don't need to know what it is.
[Self-Portrait with Dr Arrieta via wikimedia]

I have written about physical autonomy as a core value before. As an SP, feedback about treating patients with physical respect seems like the very least I can do. But full autonomy is about respecting the whole patient. Either way, consent is a requirement.

Consent is only consent if it is informed consent. But informed consent is not a ham-handed attempt to shock and awe. No, informed consent is a delicate and nuanced thing. Rather than an intimidating stack of papers as thick as a brick, informed consent is a beautiful waltz of informer and informed. Rather than a mad chaos of anxiety and pressure, informed consent can be a quiet and deliberate Sunday morning. Informed consent invites inquiry and empathy rather than blame and scrutiny. Informed consent should relieve ambiguity and bolster confidence. Informed consent should ideally take as long as it damn well needs to. That's why asking "Do you have any questions?" or "Is that OK?" isn't enough.

Of course, all of that's often not possible in the constraints of an SP encounter, even the long-form scenarios. But when a student genuinely tries to include consent in an encounter, I am relieved and delighted.

A student who excels in consent:

• Identifies procedures before they happen
• Asks permission
• Waits for recognition/response
• Uses simple language to describe complex topics (e.g. AGUS, screening vs. diagnostic)
• Keeps inviting questions until I don't have any more. Consent without comprehension isn't consent. 
• Asks questions that have more than one possible answer: how can I say truly say yes if i don't know what no will mean? As a patient I will say "yes" because I assume the consequences of saying "no" are worse.
• Does not ask leading questions (e.g.: "You don’t mind if I’m touching you like this, do you?")
• Tells me the range of options, not just the worst or best one
• Confirms my understanding using "teach back" or other concrete methods

Extra credit!
I was recently asked to sign things in a hospital. I was asked to sign them without having read them first or know what I was signing for. One was for HIPAA. When I asked to read it, I was told, "It's the same thing you sign everywhere. You've been signing it since 1996 or something." In other words, "You give me permission to do everything on this piece of paper that I’m not going to let you read, right?" This is a poor, but appallingly common, example of respecting patient autonomy.

Discussion question: 
Consent can lean towards coercion when a power differential is involved. Why is that?