Thursday, May 17, 2007

Psychiatry residents often skip informed consent

By Will Boggs, MD

NEW YORK (Reuters Health) - Psychiatry residents tend to take a "passive approach to informed consent discussions" when presented with common clinical scenarios, according to a report in the Journal of Clinical Psychiatry.

"Since it appeared that residents in our study failed to actively bring up the topics necessary to obtain informed consent, educating them that they must do so may remedy the problem," Dr. Bret R. Rutherford from Columbia University, New York told Reuters Health.

Informed consent refers to the communication between a physician and patient in which the physician discloses enough information so the patient understands the treatment or procedure he or she is agreeing to have - or not to have. The physician will typically provide the diagnosis, the purpose of treatment, the risks and benefits, and other relevant information. In turn, the patient should have the opportunity to ask questions.

Rutherford and colleagues investigated the informed consent practices of 108 psychiatry residents by assessing their responses to clinical vignettes describing three hypothetical patients with major depression, borderline personality, or neurotic character traits.

Only 8 of 324 completed vignette responses (3 percent) met the criteria for adequate informed consent, the authors report, and only 3 of 324 met criteria for optimal informed consent.

When revised criteria, which counted answering patients' questions, were used, more than half the vignettes met the criteria for adequate informed consent, and one third of the residents met the revised criteria for all vignettes.

"Initially, we were surprised that so few residents met our criteria for informed consent," Rutherford continued. However, when the data were reanalyzed to include what residents were willing to answer, the majority did meet criteria for informed consent.

"That told us the problem was not that the residents lacked knowledge about the elements of informed consent, but they failed to actively...bring up these issues with their patients."

The results "suggest that changing residents' passive approach to informed consent discussions might have a large impact," the investigators write.

"Residents (and, apparently, all other physicians, given similar findings by other researchers) need to see it as incumbent upon them to proactively bring up informed consent issues with their patients and not simply answer the patients' questions if they ask," Rutherford concluded.

SOURCE: Journal of Clinical Psychiatry, April 2007.