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Monday, June 16, 2014

Informed Consent - The Treachery of Images

Rene Magritte's painting, "This is not a pipe"
Some things are not what they seem.  Take one of my favorite paintings for example.  If I asked you what you see, most people would say a pipe.  But, written in French underneath, it states, "This is not a pipe."  Well then, what is it?  It is just an image, a picture of a pipe - you can't actually use this pipe!

Why the art history lesson?  Because it is the best way I can explain to you what is and is NOT informed consent in medicine.  Most people, when they think of informed consent, think of a piece of paper they are asked to sign shortly before some  procedure or event occurs.  Its usually a highly scientific paper with tiny print that most people don't even read before signing.  Just like the image of the pipe, it looks like something useful and meaningful, but in reality its not, it's just a piece of paper.


Informed Consent is the meaningful discussion of the good and bad things that could happen to you if you agree to what your doctor is asking you to do or offering to do for you.

As a patient, you need to insist on this conversation - it is your body, and you will live with the outcome of whatever happens.  So, how do you have this conversation with your doctor?  Here are some tips:

1) Start off by asking who will do the procedure - are you actually talking to the person who will be doing or assisting in the procedure?  Does this person know enough about the procedure to answer all your questions?

2) Ask why this procedure is necessary and what all your other options are.  What happens if you choose to do nothing?  What other types of surgery or procedures are similar to the one being offered and why is your doctor recommending this one?

3) Do not be afraid to get a second opinion.  Medicine changes quickly and there is also a big difference in how surgeons or other doctors who do procedures learn what they do.  If something doesn't feel right, ask for an opinion from one of their colleagues or a different group.  A doctor who gets upset and angry at this request is NOT someone you want to work with.

4) Ask for time.  If a situation is truly a life-threatening emergency, a doctor technically does not need to tell you the risks and benefits because she assumes you want everything done to save your life.  You're in pretty bad shape and usually not with it at this point.  If that is not your situation, you have time.  It may mean rescheduling your surgery, it might mean making someone cranky, but at the end of the day, you need to feel ready for this.

5) Think of whatever procedure you're having as an investment in yourself.  You want to feel good about this and know this will help you somehow.  It might mean less pain, a longer life, getting around easier - decide what it means for you to get this done!  Now also think of ALL the bad things that could happen - not just death, but infections, pain, not being able to eat, drink, go to the bathroom, talk, walk by yourself, and anything else that matters to you.  Find out how often these occur and then decide.  Ask your family and friends for their opinions too - but ultimately, its your decision and your body!


  1. Excellent insights! Thanks for writing this guide!

  2. Informed and engaged patients are a critical component of effective health care outcomes and you're doing a great job by helping us by sharing ways to do that! Thanks, Julia, and best of luck blogging. I think you'll love it!

  3. Welcome to the blogosphere: Follow me on twitter @glevin1 or

  4. Julia, I'm a big fan of Paul Levy and found your blog because I'm on his email newsletter list. I love how you broke down informed consent into something so simple yet important. I'd honestly never thought of it this way. Your analogy to art is also awesome. Have you seen "The Fault in Our Stars" yet? The main character Hazel has this image on her shirt and describes what it means in the movie. Not sure if that was your inspiration, but either way, great entry into the blogosphere. I look forward to reading more posts.

    1. Thanks Ariana - I'll have to put The Fault in our Stars on my reading list - I really appreciate the recommendation!