A 55-year-old woman with advanced metastatic breast cancer comes to the emergency department for evaluation of dyspnea and tachycardia. The resident evaluates the patient and orders an echocardiogram, which confirms the presence of a pericardial effusion. The surgery team is consulted, and the surgical attending informs the patient that a pericardiocentesis is necessary. The attending surgeon then receives an urgent page and asks the resident to obtain informed consent for the procedure. The surgery resident has neither observed nor performed a pericardiocentesis but has recently read an article about malignant pericardial effusions. Which of the following is the most appropriate course of action by the resident?

Question

A 55-year-old woman with advanced metastatic breast cancer comes to the emergency department for evaluation of dyspnea and tachycardia.  The resident evaluates the patient and orders an echocardiogram, which confirms the presence of a pericardial effusion.  The surgery team is consulted, and the surgical attending informs the patient that a pericardiocentesis is necessary.  The attending surgeon then receives an urgent page and asks the resident to obtain informed consent for the procedure.  The surgery resident has neither observed nor performed a pericardiocentesis but has recently read an article about malignant pericardial effusions.  Which of the following is the most appropriate course of action by the resident?

Quizplus · Accepted Answer

11ec160b_365e_daa3_9249_0f1d0e3526a0_MD0001_00 Informed consent (IC) is a process in which a patient agrees to medical treatment based on an adequate understanding of the pertinent facts. The basic elements include: IC is best obtained by the attending physician performing the procedure, who can most adequately explain the procedure in detail and answer any questions. In some jurisdictions, IC may be delegated to another physician or mid-level provider (eg, physician assistant) on the care team; however, the team member must also have a thorough understanding of the procedure. Because of lack of experience with this particular procedure, the resident is not qualified to obtain IC. The resident should therefore ask the attending to return to obtain IC. (Choice A) The emergency department attending will not have responsibility for performing the procedure and therefore cannot obtain IC. (Choice C) Patients must be given adequate time to read a consent form but this is not an appropriate replacement for a direct conversation with the physician. Although some institutions require a witness to be present during signing, this does not otherwise alter the obligations for IC. (Choice D) Patients may ask additional questions regarding treatment after giving consent and may withdraw consent at any time. However, the patient should not sign an IC document prior to an adequate discussion. (Choice E) While awaiting the attending's return, the resident may obtain additional information to educate the patient. However, reading third-party references without having a thorough understanding of, and experience with, a particular procedure is not adequate to obtain IC, especially for a high-risk procedure (eg, pericardiocentesis). Educational objective: Informed consent (IC) should be obtained by the attending physician performing the procedure, who can best explain the procedure and answer any questions. If IC is delegated to another provider on the care team, the team member must thoroughly understand the procedure and be able to answer the patient's questions. __________ References: Twelve tips for teaching the informed consent conversation. (http://www.ncbi.nlm.nih.gov/pubmed/29361861) Improving the informed consent conversation: a standardized checklist that is patient centered, quality driven, and legally sound. (http://www.ncbi.nlm.nih.gov/pubmed/26194737)

A 55-Year-Old Woman with Advanced Metastatic Breast Cancer Comes to the Emergency