The surgery doesn't have to be that stressful if you prepare properly for it. Expert Rafał Janiszewski, the owner of the Advisory Office providing services in the field of he althcare organization for medical entities and patients' rights, gives important tips and talks about the formalities that must be met before the procedure.
Anna Tłustochowicz: How should I prepare for the surgery?
Rafał Janiszewski:Apart from purely medical preparation, which is usually recommended by the doctor, and it may concern, for example, restrictions related to diet, i.e. sometimesbefore the procedure we have to be fasting.In addition, getting to know what will be the subject of treatment is quite an important element. The therapeutic entity, and in practice the doctor most often, must inform us how the procedure will be performed, what it is about, what the consequences of withdrawing from the procedure may be.
What can happen if we don't decide to have an operation?
We also need to knowwhat possible complications or results deviating from the expected effectmay occur. Such knowledge should be presented to us by the doctor so that we can consciously consent to the procedure.
This is a very important issue, because according to the Patient Rights Act, the patient agrees to all procedures (including interventional, diagnostic, etc.) that are to be performed.
If this treatment is risky, we must give such consent in writing. This is most often the case with more serious procedures, such as surgery, but also, for example, when chemotherapy is started. Then , as a rule, we are presented with a consent form , under which we sign. In this print, we will find all the elements that I have already talked about, i.e. the description of the procedure, risk-related elements and so on. I would like to emphasize thatthe law says that the patient gives informed consent . So we get a print and we can read it calmly before signing.
But we don't always have to consent in writing, right?
True. Today we mainly talk about surgeries, but of course there arethe types of treatment in which we can be informed in writing.However, we do not have to express our consent in writing.
So why do we get written information?
Just so that we can get to know each other and ask questions about what will be done to us. Even if it is a procedure not related to any particular risk, or even not related to it at all, if it is a procedure for which oral consent is sufficient -it is still very important that we give informed consent . And the patient must know what he is agreeing to.
Even for ordinary ultrasound.
Oh yeah! And we give our consent orally, be deeds.
By deed?
Sure! When the doctor says: "Please lie down, I will do the ultrasound" and the patient goes to bed, it means that he / she agrees to the ultrasound, right? The same is true when the nurse asks for the preparation of the hand from which the blood will be drawn, and we extend our right or left hand. Our behavior means that we consent to the fact that the medical staff perform some activity in relation to us.
Sure.
Please also note that sometimes we don't get the information in hand, right? It happens, for example, that in front of the ultrasound room or in the registration, you can find information about specific procedures. And while waiting for the treatment, we can dispel all doubts so that we can undergo this treatment or not. And sometimes it is also the case that we receive specific recommendations. Let's say we have a bladder examination and we receive a written message that we should drink a lot of water beforehand. This is all building the patient's awareness of what is going to be done to him.
However, sometimes - especially when it comes to complicated operations or treatment, such as the aforementioned chemotherapy - the patient will say: “Doctor, it is too difficult for me, please act. I trust you. "
Correct, but it does not change the fact that then the doctor must exercise due diligence in order to explain to the patient - using language that the patient understands what will happen, and must answer all questions that may arise.
The doctor must be convinced that the patient is aware of what is going to happen.
You strongly emphasize the importance of informed consent, therefore: we have given informed consent and we are going to surgery. What's next?
We can always withdraw your consent.
The night before the surgery I had a bad dream and I said: “Oh! It was a sign. I am afraid, I do not want this operation. "
We come to the blockoperating and we say, "No, no, no! I have bad feelings!".I have the right to do so! I can withdraw my consent at any time.
And doctors should not persuade then?
They should try to find out the reasons for changing our mind and they should explain to us what threatens us if the procedure is not actually performed. After all, the doctor has a duty to care for our well-being and knows perfectly well that we need this surgery. That without it, our he alth will deteriorate to a greater or lesser extent. That there may be an alternative treatment that will only heal the disease, not cure us. That is all, once again, we must be told. Do not persuade! Explaining in order to - build awareness of this decision of ours again.Because opposition must also be aware!
The patient must know that by changing his will, he can harm himself.
Because then he will say: "Yes, I dreamed about my late grandmother and I thought it was a bad omen", but I did not think that my disease would go so far! I was not aware that two weeks later it would be too late for surgery! ”. Let us assume that the patient has made up his mind, agreed and the operation took place. He gave informed consent to the removal of the appendix. Meanwhile, during the operation, while he is sleeping, the surgeon notices a change in the abdomen that he did not know existed before.
Cancer!
Whatever. Some change. Which must be removed for the benefit of the patient. And now what is the doctor doing? After all, no one will raise a sick person in order to tell him about it and ask for permission to cut the lesion! He himself will decide to modify the procedure, to extend it. It results directly from the Act on the Profession of Physician and Dentist, thatin such a situation the doctor makes this decision taking into account the good of the patientand in order to perform the procedure in the best possible way. A different situation may also occur: I have consented to the operation of radical tumor removal …
And it turns out that there are already metastases in so many organs that it makes no sense?
For example. Or for some other reason, the surgeon concludes that the tumor cannot be radically removed and will not perform the surgery for which I consented. And the doctor also has every right to do so. He also makes such a decision himself, and most often in consultation with the operating team.
Please tell me what the law provides in a situation where the patient is not able to consent to the procedure on his own.
We have our own consent and a surrogate consent, of course, when another person agrees for the patient.
Parent for child?
More: guardians for a minor. Yes of course. But here's one thing: if a child is 16 years old and older, then we are talking about a parallel consent, i.e. both the 16-year-old consenting to the operation and his legal guardian must also give such consent.
There is of course also a surrogate consent, which does not apply to children, but to adults for whom someone is a legal guardian.
Are you talking about incapacitated people?
Yes, of course. It is most often the situation where adult children have been appointed by the court as legal guardians and guardians of their parents. However, here is also an important note: if this adult child agrees to have his mother or grandmother perform the operation, but mother or grandmother remain in verbal-logical contact, then we also use parallel consent.We must take into account this person's opinion!The catalog of substitute consents also provides for such a situation when the consent is given not by the patient himself and not by the person who is his legal guardian!The consent is expressed by someone who is the actual guardian.The court did not authorize her to do so, did not establish it, but in fact she takes care of the patient. Often it is a grandmother in relation to a granddaughter. It sometimes happens that it is a neighbor or a neighbor in relation to the neighbor.
Neighbor agrees to be operated on by neighbor?
Of course I do! If, for example, it is a lonely, elderly gentleman who is looked after by a neighbor. She does his shopping, she has been "looking after him" for years, she makes sure that he takes his medications. And now he felt worse, so this lady brought him to the hospital and there it turned out that an operation was needed, that we had to give consent for it, and in the meantime your condition worsened and you are unconscious. And then the neighbor says: "I declare that I am the de facto guardian of Mr. Xsiński and agree to perform the procedure for him". This is the situation our law most anticipates.
What else is there for?
A situation where there is verbal and logical contact with the patient, but he is not able to physically perform the act of signing the consent. Oh, first example: a motorcyclist has had an accident and both arms are broken. Or there's a person who has hand tremors as a result of a neurological disease, right?
There can be no question of expressing written consent, but there must be written consent!
What then?
The consent is then taken orally, with an annotation that the patient could not sign the document, but gave oral consent to the procedure and did it in the presence of the employeemedical facility.
What if the patient is also unable to express consent orally?
Then he may do itin any other way that clearly indicates he agrees!For example, he may nod his head in affirmative terms or blink his eyes. And the staff, of course, describes it in agreement.
On the other hand, when the patient is unconscious and there is no one with him to consent to the procedure, and it is a he alth and life-saving procedure, it is performed without consent. Please explain more about the access to information about the patient's he alth?
The patient also gives his or her informed consent, of course.Before the procedure, he signs a written consent to inform a third party about his he althand to make his medical records available to a third party. This is an extremely important matter, because we must remember that medical personnel is bound by professional secrecy!
It should also be clearly emphasized that consent to inform a third party about our he alth condition and to share our medical records with them - these are two different documents!
I can allow the staff to talk to my husband about my state of he alth, but to share my records with him - no?
That's right. And then, even if it is the closest member of our family, he will not have access to medical records - without the consent of the court - he will not have. Finally, it is worth mentioning that the people we want to receive information about our he alth condition or our medical documentation - we can indicate in advance in IKP.
Once again in our conversations you indicate the benefits of this solution.
As it is handy,a personal tool for each patient . In the situation we are discussing, it can also be very useful for medical staff, when, for example, a patient is admitted to the hospital unconscious, and thanks to the information from IKP it is known which people close to the patient and for what they have been authorized by him.
Expert
Rafał Janiszewski, owner of the Advisory Office providing services in the field of he althcare organization to he althcare entities
Speaker, organizer of many trainings and conferences on he alth protection and patient rights. In the years 1998-1999 an employee of the Office of the Government Plenipotentiary for the Implementation of the General He alth Insurance. Author of over 20 books on he althcare organization and he alth care financing standards. In 2005-2007 an expertPresidium of the Parliamentary He alth Committee, as an advisor for he alth services. Co-author of the general study as part of the Pharmaceutical Pricing and Reimbursement project for the European He alth Commission.
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