Nov 302012
 

“We have to tell you these awful things can happen, but thank goodness, they don’t happen.” – L&D nurse regarding the possible complications listed on a blood transfusion consent form, to a patient with a rare complication of labor.

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 November 30, 2012  informed consent, L&D Nurse  Add comments

  15 Responses to ““We Have To Tell You These Awful Things Can Happen, But…They Don’t…””

  1. Thank you so much I feel so reassured. (sarcasm)

  2. I was just talking about this with someone yesterday! That yeah, sometimes it’s a one-in-a-thousand chance, but if you happen to be the one in a thousand it happens to, then that’s pretty darned important!

    Yeah, “they don’t happen.” They don’t happen if you’re in the hospital because the hospital has magical powers, but the hospital has high mages in legal robes who craft magic documents listing possible complications, and you have to sign off agreeing that they could happen even though they can’t possibly happen in a hospital, and then if they do happen, even if you only signed the form because the nurse told you it wouldn’t happen, you still signed a form admitting you knew they could happen. Guess what holds up in court? Your signature.

    It doesn’t matter that people use the word “never” to mean “hardly ever.” This nurse might not even have realized what s/he said because that’s how people have migrated the word.

    “Your honor, I did give her the informed consent sheet. I told her these were rare complications, but of course they happen. They’re right there on the consent sheet.”

    “Your honor, she said ‘never.’”

    “I wouldn’t say ‘never.’ It’s right there on the consent sheet!”

    Complications happen. Medical Types, please just give us the facts. Don’t tell us uterine rupture is a 100% guarantee with VBAC, and don’t tell us complications after medical treatment are 100% impossible. Informed consent starts with factual information.

    • “Complications happen. Medical Types, please just give us the facts. Don’t tell us uterine rupture is a 100% guarantee with VBAC, and don’t tell us complications after medical treatment are 100% impossible. Informed consent starts with factual information.”

      exactly. This is exactly what I perceive to be at the heart of the unmedicated birth movement. We want factual, scientifically peer reviewed evidence upon which to base our decisions. If we choose to have interventions, at least let us have them knowing all of the actual risks, not the exaggeratedly inflated or diminished risks.

      Now after that and my Insanity workout my blood is pumping!

    • Jane wins the gold star today.

    • Actually a consent form is useless in a civil court, you can sign a stack of things saying you understand the risks and won’t hold your doctor accountable, it means nothing if you decide to sue for a rare/misdiagnosed/neglegent side effect. They make you sign because most of the time *you* (generic you) don’t know that so you are much less likely to seek legal help because you think, well, I signed the form. And if you do try to seek legal help the hospital can call and threaten and waive your signature around to make you back down before you contact a lawyer. But, legally, those consent forms aren’t worth the ink they used to print them.

      • Hmm. I don’t like that. I don’t like the idea that I can take full responsibility for something and then my doctor could still be held accountable for the ramifications of my decision.

        If a doctor and a patient in conjunction decide on a specific treatment with specific risks, and the patient willingly takes the treatment — heck, if the patient lobbied the doctor for that treatment — then the doctor should be protected from lawsuits if the patient dies and suddenly the patient’s heirs decide they want a free ride to college on the insurance company’s dime.

        Right?

        • In principal I totally agree, in principal a signed consent form *should* relinquish all responsibility excepting neglegence. In reality it’s one of the only times medical law reflects a reality. As we see on this site and in most of our first hand experiences these things are poorly written (blanket consent), almost never properly explained, and frequently contradict verbal instructions from the doctor/provider, and are usually signed in such a manner that informed consent is nearly impossible (‘here, sign this *now* or we can’t help you’ whilst your in peril or undue pain/injury/stress while they shove four different forms under your nose). It certainly isn’t a perfect situation, I think, for instance, a form that is written by the patient or has been altered by the patient (proving they were paying attention when they signed it) and counter-signed by the doctor *should* be treated as a legal proof of consent/release from harm. but given the reality of the situtations common I’m glad people who have been forced to sign a paper (by hook, crook, or threat of witholding care) still have some form of legal recourse.

  3. I assume that this nurse was probably trying to be comforting in telling the mother that they “never” happen, but yeah…like Jane said, if I’m signing a consent form saying it can happen, it’s kind of stupid to tell me it doesn’t happen.

  4. Great, then there’s no need to sign this form.
    …oh, I do, then let me just change it to reflect the lack of possibility of complications your “never happens” indicate.

  5. Never and Always should be removed from language almost entirely.

    I can’t think of anything except gravity that is a guarantee.

    For example: Normal human body temperature is ALWAYS 98.6 degrees F.

    FALSE: My normal body temp is 97.5, my husband’s is closer to 99.

    So medical professionals: Take the words always and never, and toss them in the trash. Don’t ever use either word again.

  6. I was in the hospital for a late postpartum hemorrhage. Late hemorrhage happens in only around 1% of births, and I had none of the risk factors. So I’m acutely aware that those tiny percentages on the consent forms are actual events happening to actual people.

    The nurse’s tone wasn’t comforting, it was rushed and dismissive.

  7. But is HAS happened to someone, somewhere, so they’re on the list. Risks are real.

  8. This is pretty much what I was told when I was admitted for an unnecessary induction. Oh yes the form said that c-section might be a possible outcome to the induction but I was told that it wouldn’t happen. Oh because nothing bad ever happens just sign the paper.

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