Communication problems are a major cause of complaint about health care among patients and family members. Not surprisingly, communication around consent and capacity is particularly important.
Think about this scene:
An unconscious patient is brought in by ambulance with no one accompanying them. The triage nurse obtains little information from the paramedics. Despite not being able to get the patient’s consent, the paramedics had started an IV. In such a situation, consent is implied due to the specific emergency context.
In Jack’s case, his daughter comes with him. While introducing himself to the patient, Dr. Shah quickly determines that he needs to get information from Jack’s daughter instead. The physician, however, does not ask Jack’s permission to get information from Penny, assuming that he would consent were he able to.
It is common practice for physicians to assume that a family member will act in the patient’s best interest. In this scene, has the need for a substitute decision-maker been adequately explored? What else could Dr. Shah have done to assess Jack’s current capacity, given that a full capacity assessment was not feasible in this situation? What would you do?
In these kinds of cases, physicians make assumptions all the time about consent, believing that the patient would agree if they were competent. Luckily, most of the time things work out. As we go through the module, think about Jack and his daughter’s relationship, unknown to Dr. Shah at the time, but later revealed. Penny provides a good deal of her father’s personal information, and agrees to his admission despite Jack’s objections.
Complete documentation, including reasons why certain decisions were made, is paramount in situations like this.