Student observers in the O.R...

Anxious Patient · Dec 23, 2010

Thanks for responding CDgirl. Can you enlighten me on something? How common is it for patients to put restrictions on the consent form. And would it be resented as meddling. I've read many threads here of difficulties dealing with ill-tempered surgeons in the operating room, and I would hate to be the one resonsible for his anger. :uhoh3:

Cul2 · Dec 24, 2010

Most patients understand the importances of on site,

hands on training of medical professionals. Most patients

will probably, if approached properly, allow medical and

nursing students to observe in the OP, depending upon

the circumstances. But -- in no way are high school students

any part of any kind of medical education. Having high school

students observe in the OR is a recruitment tool. Recruiting

is fine -- but in cases like this it puts patients in the position

of objects, something to be used by the institution for it's,

not the patient's, benefit.

Although I'm not opposed to free choice (if patients agree

to this), I seriously question whether there is real informed

consent when the observer is a minor. (as I've posted above).

Even when the observer is an actual medical/nursing student,

as has been mentioned above, too much leaway is given in

consent forms without actually "informing" the patient. The

patient should always be informed verbally and asked verbally

for permission if those in charge plan to have observers.

Some patients who are duped into these situations, and later find

out about it, become very cynical and mistrusting of the whole

medical establishment. Honesty and complete information up

front is nearly always the best idea.

sharkdiver · Dec 24, 2010

Anxious,

I've never worked in the OR environment, so I can't comment from that aspect as others here have so eloquently done. It is my opinion, however, that access to the OR during a procedure should be limited to necessary personnel only unless the patient has given explicit permission otherwise. Burying that permission in a vague statement in the fine print on a pile of consent forms is, IMHO, deceitful.

As Cul2 said, most patients realize the need for training and in most cases would allow medical and nursing students to observe a procedure if asked in a respectful manner. High school students, on the other hand, are neither medical professionals nor professionals in training, and have absolutely no business being there, as I said earlier, without both the explicit permission and full knowledge of the patient.

And if the patient doesn't want any extraneous personnel present, that wish should be respectfully honored as well, without comment or argument. No patient should fear that the refusal to allow students or observers to be present will in any way effect the quality of care they will receive, and they should be told that. For any medical professional to allow it to do so would be highly unethical. As far as I'm concerned, this should extend to any medical test, treatment or procedure, not just those in the OR.

I agree that being open and upfront with the patient is the best policy.

canesdukegirl, BSN, RN · Dec 24, 2010

Thanks for responding CDgirl. Can you enlighten me on something? How common is it for patients to put restrictions on the consent form. And would it be resented as meddling. I've read many threads here of difficulties dealing with ill-tempered surgeons in the operating room, and I would hate to be the one resonsible for his anger.

Great question. The surgeons that I have worked with by and large are very thorough at explaining the consents. They do so in a way that anyone can understand, and actually drop the medical jargon while speaking to patients about their surgery. I am very impressed with their ability to walk the fine line of fully informed comprehensive consent v. "dumbing it down" in a way that may insult the intelligence of the patient. The surgeon gives the patient every option available to them. Sometimes the patient chooses to do something that the surgeon sees as the greater of two evils-for example, I was in a case where a pt had a tumor at the trifurcation of the popliteal artery. There were several surgeons involved with her care-ortho, vascular, surgery oncology and plastics. The tumor could not be resected in its entirety because of the way it was growing, but it could be mostly removed. The vascular, plastics and ortho docs wanted to amputate. The surg onc surgeon wanted to save her leg. The patient was given both options-a lengthy procedure to resect the tumor with a subsequent bypass graft so that the leg would perfuse, and plastics would close. Because the tumor could not be removed in its entirety, there was a very good chance that the tumor grow again in about 5 years. The patient wanted to save the leg. So, we did everything possible to save the leg, and we did. The surgeons all worked to that end, whether they concurred with the plan or not because that's what the patient wanted.

It is not seen as meddling AT ALL. The surgeons want what the patient wants, and will work very hard to accomplish that, without ire and without bringing their own differences into the OR. They understand that it is the patient's right and the patient's choice to disagree or to tweak the procedure. The surgeons are all for it.

As for how common it is for a patient to change the consent, in my experience, patients do so rarely. If this does happen, however, the surgeon will confer with the patient and family to come up with a plan that is safe and fits the desires of the patient. Sometimes we have canceled surgery until the patient can come to a decision that they feel good about. I have seen this a lot with tumor cases. The surgeons are very much supportive of the patient's decision.