A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed the full treatment algorithm. I answered their questions and concerns. They seemed appreciative and understanding. Ultimately, he signed his consent for surgery. I left the room feeling I had taken good care of this patient.
On my way to book his surgery, his wife catches up to me before I can leave the emergency department. “There’s a problem with this consent form,” she explains. She points to the very first clause. The gist: This is a teaching hospital, and residents will be involved in your care. “We are not OK with residents. He is not one of those patients. We have good insurance.” The request was unapologetic and matter-of-fact.
Here are the things that I said to her:
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