drawing of booksModule 2 – Unit 5:  Reading & Vocabulary

Obtaining Informed Consent

Think About It   What is meant by “ informed consent”? Why is it called “informed” consent?  What are some situations in which a patient would need to sign an informed consent form?

Below is an example of a surgical consent form used by many hospitals and clinics. Scan the form and answer the questions that follow.

VALLEY VIEW HOSPITAL

INFORMED CONSENT FOR OPERATION AND ANESTHESIA

DOE, JANE 48 F
#3729-48933    1023-58
Dr. JANICE NG

1.  I have been advised to undergo the following operation or procedure:  laparoscopic cholycystectomy . Description of procedure in common language: __removal of gall___ bladder using 2 tubes inserted into the abdomen____________________________________ ___ 

2.  Dr. Janice Ng                has described to me the nature of the operation or procedure and anesthesia. The attending physician or surgeon is Dr. __Janice Ng______

3.  The purpose and benefits of the procedure have been reviewed including but not limited to: __relieve pain caused by gall stones_________

The more common risks or potential for serious harm associated with it were discussed but not limited to: __infection, bowel perforation, and bleeding. The alternative methods or treatment and their risks were reviewed but not limited to: _traditional gall bladder surgery 

I am satisfied with my understanding of the risks, benefits and alternatives.

4.  I have had an opportunity to ask questions concerning the operation or procedure,

anesthesia, and any doubts, fears, or concerns. I am content with the responses I have received.

5.  I have read the information on the back of this consent form describing the general risks of surgery, anesthesia, and transfusions. I am satisfied with my understanding of it.

6.  I hereby request and authorize ___Dr. Janice Ng               and/or surgeons and/or assistants of his/her choice including interns/residents and personnel assigned by the hospital to perform the above described operation or procedure upon the patient. I acknowledge that the success or result of the surgical procedure has not been assured or guaranteed.

__________Jane  Doe____________________________________             __9/6/05   7:15 PM                           SIGNATURE OF PATIENT OR AUTHORIZED REPRESENTATIVE             DATE AND TIME    ___________________________________________________          ___R. Gonzalez R.N._____   

RELATIONSHIP OF AUTHORIZED REPRESENTATIVE           WITNESS TO THE SIGINING 

         ___________________________________________________________________________

                                         IF PATIENT IS UNABLE TO SIGN, GIVE REASON

Physician Declaration: I have explained the contents of this document to the patient or authorized representative and have answered all the questions. To the best of my knowledge, I feel the patient or authorized representative has been adequately informed to consent to the operation or procedure.

___________Janice Ng M.D._________                    ______9/6/05_______________

PHYSICIAN’S’ SIGNATURE                                                    DATE

Questions About Reading

  1. Legal documents such as surgical consent forms are often written in legalese, a specialized type of legal English that is different from everyday language. Match the sentences in legalese below with the “translation” you might use with a patient. Write the correct letter on the line.

    Legalese:

    ___  I have been advised to undergo the following operation.

    ___  The purpose and benefits of the procedure have been reviewed. . .

    ___  I hereby request and authorize Dr. Janice Ng. . .

    Translation that you might use with the patient:

      1. The doctor explained the reasons for the operation and how it can help you.
      2. You are giving permission to Dr. Janice Ng. . .
      3. The doctor told you that you should have a gall bladder operation.
  2. What does “authorized representative” mean? (See No. 6 on the form.)
    1. A professional authorized to represent the hospital
    2. A person who can legally make informed decisions for the patient
    3. A person authorized by the doctor

  3. Only the surgeon (whose name is written in the space in No. 6) has permission to perform the operation.
    1. True
    2. False 

  4. The phrase “To the best of my knowledge,” (see No. 8 on the form) means that:
    1. The physician is sure that the patient is adequately informed to give consent.
    2. The physician has done his or her best to be sure that the patient is adequately informed to give consent.

  5. Translate the legalese of No. 4, 5, and 6 on the surgical consent form into common English, as if you were explaining the form to a patient.

No. 4 _____________________________________________________________________

__________________________________________________________________________

No. 5 _____________________________________________________________________

__________________________________________________________________________

No. 6 _____________________________________________________________________

__________________________________________________________________________