Thomas G. Orr Memorial Lecture. Surgical informed consent: what it is and is not.

A more systematic approach to addressing the crucial issue of informed consent is needed in medical education. Surgeons cannot afford gaps in their medical education regarding the communication process with patients. We found that many surgical residents and faculty understand the mechanics of the informed consent process quite well and could perform well under the artificial circumstances of our video interview. Whether they would do as well if a real patient was considering nonoperative therapy, or was a ne'er-do-well, or an alcoholic is not known. Two main causes of interference with the process have been identified: conflicting messages which surgeons get from within the profession, from the courts, and from within themselves and lack of time for dialogue with patients, and poor timing of the consent process. Areas that were uncovered that need further investigation include the barrier created by some surgeons' internal, often unrecognized, biases about surgery being the only satisfactory mode of treatment for some illnesses and some surgeons' belief that longevity should be the goal of all therapy, without considering that for some patients, maintenance of certain quality lifestyles is more important than a longer life. We hope that surgeons can learn to look at the informed consent process as a wonderful opportunity to communicate their personal concern for the patient as a person, not just a sick gallbladder to remove, and that this process can become the channel through which the wounded relationship of the patient and the physician can be healed.