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An investigation into the practices of 108 psychiatry residents revealed an excessively passive approach to informed consent discussions with patients. Asked to participate in hypothetical clinical vignettes, only 3% of the students managed to provide responses that met the criteria for adequate informed consent.

Psychiatry residents often skip informed consent

Date Published:

Apr 01, 2007 01:00 AM

Author: Will Boggs, MD

Source: Journal of Clinical Psychiatry

NEWYORK (Reuters Health) – Psychiatry residents tend to take a “passiveapproach to informed consent discussions” when presented with commonclinical scenarios, according to a report in the Journal of ClinicalPsychiatry.

“Since it appeared that residents in our studyfailed to actively bring up the topics necessary to obtain informedconsent, educating them that they must do so may remedy the problem,”Dr. Bret R. Rutherford from Columbia University, New York told ReutersHealth.

Informed consent refers to the communication betweena physician and patient in which the physician discloses enoughinformation so the patient understands the treatment or procedure he orshe is agreeing to have – or not to have. The physician will typicallyprovide the diagnosis, the purpose of treatment, the risks andbenefits, and other relevant information. In turn, the patient shouldhave the opportunity to ask questions.

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

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

When revisedcriteria, which counted answering patients’ questions, were used, morethan half the vignettes met the criteria for adequate informed consent,and one third of the residents met the revised criteria for allvignettes.

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

“Thattold us the problem was not that the residents lacked knowledge aboutthe elements of informed consent, but they failed to actively…bringup these issues with their patients.”

The results “suggestthat changing residents’ passive approach to informed consentdiscussions might have a large impact,” the investigators write.

“Residents(and, apparently, all other physicians, given similar findings by otherresearchers) need to see it as incumbent upon them to proactively bringup informed consent issues with their patients and not simply answerthe patients’ questions if they ask,” Rutherford concluded.

SOURCE: Journal of Clinical Psychiatry, April 2007.