There has been a lot of talk recently about informed consent regarding surgical procedures. Most of this talk has been centered around the spate of cases involving unnecessary stent placement. While informed consent is a wonderful thing especially when the patient has time to digest what information they have been given, it can work against the patient as well when time is of the essence. Unfortunately when the patient is in an emergency situation such as having a heart attack, informed consent falls by the wayside.
When I had my heart attack back in 2009 everything seemed to happen so fast as soon as I entered the emergency room. As soon as I told the admitting nurse what was going on with me, IE chest discomfort and a shooting pain in my jaw, I was immediately taken to a room where my shirt was taken off and an EKG started. No less than 2 doctors were present and while one was administering the EKG another was taking blood. The EKG showed a minor anomaly but before they could re-administer the test the other doctor returned with the news that there were enzymes in my blood, I had had a heart attack.
The doctor informed me that an ambulance was waiting and I would be taken to the hospital down the street because they had a cardiac catheterization lab ( cath lab ) where I would receive the care that I needed. I was confused and very scared at this point and all the previous actions happened in the span of just 15 minutes.
When I reached the new hospital I was taken from the ambulance and rolled no more than 50 feet into the hospitals cath lab, which was already full of people waiting for me. As soon as I was in the lab IV’s were started and the operating doctor was standing over me. He quickly explained the catheterization process. An incision would be made on my inner thigh and a catheter with a small camera would be threaded through my femoral artery up to my heart, where they would begin the process of searching for the blockage.
While all the doctors in my case were very good at informing me of what was going on and what they were doing to help me there wasn’t time for them to explain every nuance of the procedures or give me an extensive history of the drug eluting stents they placed in my artery , not to mention the fact that I had never heard of a stent before and would have gone with the doctors decision anyway as he knows best, right?
Here’s the real problem when it comes to informed consent in an emergency, I was alone, scared and my mind was racing a million miles hour, even if there was time for the doctors to explain the pro’s and con’s of stenting and drug eluting stents I wouldn’t have digested that information in a rational way…I was having a heart attack! I knew nothing about the catheterization procedure or the stents used and as far as anyone knew time was ticking and I could have another heart attack at any second.
In cases such as this informed consent is almost meaningless but the after care is of paramount importance. After the emergency is over the doctor needs to sit with you and explain in detail what took place, what procedures were used, what devices were used or implanted and the significance of this is on your health and life.All your questions need to be answered in a setting where you are ready to digest all the information.
Because the recent problems concerning what some believe as unnecessary stenting in several states there is now a call for better informed consent before beginning these procedures. While I agree that informed consent is a good thing in most cases, in an emergency such as a heart attack there just isn’t time and the patient would unlikely understand what was being said even if they knew beforehand about stents and catheterizations.
I believe the majority of medical professionals have your best interest at heart and they also have the knowledge that we as laypeople don’t. If you are having a kidney stone removed then by all means informed consent is a blessing, when you are having a heart attack informed consent could kill you.
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