Consent for Surgery: What Does it Really Mean?

Recently, a fellow surgeon and I had an interesting discussion about consent for surgery, which was relevant because I had just seen several patients who had visited other surgeons and had procedures done without their consent.

For instance one patient went in for a lower eyelid lift and ended up with extensive scars across her temples.  Another paid for liposuction of one area yet the liposuction was performed on other areas as well with devastating results.  My colleague also recounted several patients he had seen with similar tales.  And we came to the same question – how can they get away with it?

The idea of the informed consent came about because of this exact thing.  Years ago surgeons were viewed as authoritarians so patients asked few questions and accepted whatever was performed.  The problem was that patients weren’t always emotionally ready for the outcome.  But times have changed and medicine as evolved.  Today there are basic rules for informed consent that center around explaining the risks and benefits of each procedure.  But for me and the 99% of other conscientious surgeons this only forms the basics of consent.

My approach to each and every patient is education.  This means describing in complete detail the procedure to be performed, from incision to closure.  Every reasonable risk and complication is spelled out in a bound booklet.  So my patients aren’t surprised after surgery.  This isn’t to say there are “gray” areas.  For me these “gray” areas consist of things like: slightly more dissection or a few more stitches needed to get the surgery perfect.  This is opposed to these arrogant surgeons who feel they can do whatever they want, for what ever purpose.  Perhaps they realize during surgery that what they planned wasn’t right, extensive enough or what they thought the outcome would be.  Whatever the reason it’s wrong to perform surgery, in a non-emergent or urgent way, without the consent of the patient or family!

As surgeons we have an obligation to educate our patients so they understand, well, what to expect.   Unexpected things can and do happen during surgery but these should still be within the realm of the planned surgery.   I pride myself on being forthcoming and the surgeon you choose should as well.

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