Putting the Information Back into Informed Consent and Refusal

Giving patients the right to say "no" without consequence.

My pregnant sister went to the hospital for monitoring after falling at home. I told her what to expect once she got to the hospital and talked her through her concerns and pain. Once she was assessed, her nurse noted that she was having contractions. 

Now, it is common for full-term pregnant people to have contractions, even if they do not hurt. After abdominal trauma, contractions can indicate an obstetrical emergency, and it is somewhat routine to have a cervical exam to rule out labor or other complications. It is also okay for a patient to decline a cervical exam given all that information. 

But my sister was kept in the hospital for several hours because she declined a cervical exam. She did not “refuse” or act belligerent, she enacted her right to decline a procedure based on knowledge of her body and the risks/benefits of the cervical exam. 

The nurse, however, told her, “Well, then we’re not letting you go since you won’t let us examine you.” Honestly. Repeat that sentence out loud. 

Once you’re as mad as I am about that sentence, think about this: Millions of people refuse medical treatment/procedures every day and are often given consequences or ridicule by healthcare providers. 

There can be a significant perception of inequality by patients, most notably if they feel the provider is condescending or “knows best.”

As a healthcare provider, I want the very best for my patients. But I also know that what I want for my patients may not be what the patient wants. And that’s okay. 

As long as I have educated my patient on the risks, benefits, and alternatives of a medication, procedure, or screening option, then the patient has every right to decline or accept treatment without punishment or derisive comments by the healthcare team. 

On the flip side, the provider has the right to refuse further treatment for a patient that declines care because the liability may be too risky. And that’s also okay! 

The most important aspect of any treatment plan is ensuring the patient is informed of every aspect of the plan, and not just what I want to tell the patient to get them to concede to my plan.

Shared decision-making between a patient and provider is supposed to be shared, not dominated by the provider because patriarchal healthcare is no care at all

Compliance is not the same as informed consent; healthcare compliance may be an acquiescence to the standard line, “Well, my provider knows what’s best for me.” No, my friends, the provider knows the best recommendation or treatment options based on conditions, risk factors, socioeconomic status, and historical medical issues. 

What is best for you is to understand why the provider is recommending/prescribing a treatment for you, and to understand that you can say no.

You don’t want a cervical exam? You don’t want to undergo a biopsy? You don’t want a specific medication? Then just say no. But in all fairness, if your provider provided you with all the education on risks, benefits, and alternatives, then have the decency to tell your provider why you are declining. If there is a lack of understanding or knowledge, then your provider can clarify those issues for you. 

Before you consent or refuse a treatment, always make sure you understand what that will mean for you and your body.

For the healthcare providers, ask yourselves why it is so important for a patient to consent to your treatment plan. Is it due to compassion for the patient’s well-being, or because you believe you know more than the patient?

Incomplete and inadequate education puts patients at risk. 

Uninformed or partially informed consent is not consent. 

Don’t put all of your success as a provider on your ability to get patients to do what you want. I am always curious about patient motives when they actively seek treatment but don’t want to follow through with my recommendations, but it is not my job to understand. It is my job to inform.

One last point to consider. The internet is full of information and not all that information is accurate or applicable to all people. If you have a medical question, ask a medical provider. 

Do not limit your decisions based on the experience or limited knowledge of some Keyboard Karen on social media.

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

PATIENT ADVISORY

Medika Life has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Medika Life

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