Consent

I was looking at a chest radiograph of my patient whose right lung was drowned in a bag of fluid. He had been taking a new blood thinner and had difficulty with breathing for two weeks. The figure of oxygen saturation was swaying up and down like a sail on a ship, as if it might capsize any time in the rough sea. Rising panic.

I washed my hands and put on my gloves. The idea is to put in a catheter and drain out the fluid, before my patient was "drowned." His daughter was standing next to me, and I promised her I'll do my best.

I didn't use a check-in-the-box list that forewarns my patient and his daughter every possible complications. All the worries with wait-and-see (when the right lung was squished and left one squashed). All those concerns with blood thinner (Oh sorry, but there isn't antidote). All the structures that I could bump into accidentally, from artery to nerve to lung to liver.

I managed that patient not long after hearing the story of Montgomery v Lanarkshire Health Board, a British court case in which a Scottish mother was awarded £5.25 million compensation in claiming her doctor who "failed" to alert a risk of traditional birth. The diabetic mother had a small build and her larger-than-average baby's shoulder was stuck at the birth canal.

One of the key implications is that patients should have been told every single risk and information. Otherwise, a doctor can be found guilty in not providing an informed consent.

Clearly, I failed in my case.

I admit that it's not easy to set a standard in the way we disclose the risk of every single medical procedure. There is always a complicating factor: our patient. To answer this question, Lisa Rosenbaum does a fantastic job of admiring paternalism in this week's New England Journal of Medicine.

To paraphrase Lisa Rosenbaum, "The spirit of informed decision making reflects the recognition that only patients are experts on their own values. But our approach assumes a value framework not all patients possess. What if the patient's preference is to know less?"