Complaint Review: Fisherman's Hospital

First of all I have some serious doubts about your medical background if you are upset about being given anti-emetic prior to being given IV Morphine. This is done Morphine causes extreme nausea to some people. Also you should also know that a hospital cannot just go out and buy stuff from a hardware store, anything involved in a procedure (which includes checking urine for gallstones) needs FDA approval and anything that could have contact with blood or bodily fluids in an ER has to either be disposed of or sterilized. Those BP Cuffs certainly are disposable and within an environment where where there is a great chance of people being covered in blood, required.

Second, there will always be a mark-up off of retail for supplies (not to mention your 'retail' prices seem to point on the low end of the quality scale), with that morphine you paying for every person from the pharmacist to the nurse who handled that drug the write offs, DEA and FDA administrative red tape, and the energy and equipment for safe and proper storage of the drug. All that adds up pretty darn fast.

I have to admit I am a bit baffled by the informed consent argument. Are you claiming that you never should have been treated? You are aware that people every day are brought to the ER unconscious or unresponsive, we aren't talking about a nose job here we are talking about very basic care. Having informed consent doesn't mean you have to be able to micromanage everything, just that you should know what is going on and have the ability to stop it and seek alternatives for treatment. The doctor will never offer you tests that he feels would be superfluous as he would have a legal duty not to.

This is just like the bank robber complaining about the dye charge. The Doctor has no problem charging his patients these enormous fees, but thinks he should get the treatment at cost.

Fun stuff.

I am making a "deal" out of informed consent for this reason. Even though I practice medicine, being the patient is different. I had no idea of the cost of the CT scans, not ordering or buying them ever before. The issue is this: Being in PAIN, the worst I've ever had (worse than 9 broken ribs in a motorcycle accident!) I should NOT have been assumed to understand everything. It is the practitioner's responsibility to DISCUSS options, even costs of treatment, reasons for ordering drug tests, etc., with the patient.

Alternate therapy, as well as the risk of DOING NOTHING are also part of the mix to be included in treatment. Fishermen's hospital is a "For Profit" entity, and their main motivation is to RUN UP COSTS for the patients who have insurance. I told them I was not going to play any more, and refuse to pay them one more cent. I made an offer of $1080 to settle, they sent my check back. Sorry, that was the last and BEST offer. They can screw somebody else, but I am finished. The Chief Financial Officer of HMA, the parent corporation makes over $1 Million a year. Is that right? Care should take care of the PATIENT, not the STOCKHOLDER.
regards
Bob

I am making a "deal" out of informed consent for this reason. Even though I practice medicine, being the patient is different. I had no idea of the cost of the CT scans, not ordering or buying them ever before. The issue is this: Being in PAIN, the worst I've ever had (worse than 9 broken ribs in a motorcycle accident!) I should NOT have been assumed to understand everything. It is the practitioner's responsibility to DISCUSS options, even costs of treatment, reasons for ordering drug tests, etc., with the patient.

Alternate therapy, as well as the risk of DOING NOTHING are also part of the mix to be included in treatment. Fishermen's hospital is a "For Profit" entity, and their main motivation is to RUN UP COSTS for the patients who have insurance. I told them I was not going to play any more, and refuse to pay them one more cent. I made an offer of $1080 to settle, they sent my check back. Sorry, that was the last and BEST offer. They can screw somebody else, but I am finished. The Chief Financial Officer of HMA, the parent corporation makes over $1 Million a year. Is that right? Care should take care of the PATIENT, not the STOCKHOLDER.
regards
Bob

I am making a "deal" out of informed consent for this reason. Even though I practice medicine, being the patient is different. I had no idea of the cost of the CT scans, not ordering or buying them ever before. The issue is this: Being in PAIN, the worst I've ever had (worse than 9 broken ribs in a motorcycle accident!) I should NOT have been assumed to understand everything. It is the practitioner's responsibility to DISCUSS options, even costs of treatment, reasons for ordering drug tests, etc., with the patient.

Alternate therapy, as well as the risk of DOING NOTHING are also part of the mix to be included in treatment. Fishermen's hospital is a "For Profit" entity, and their main motivation is to RUN UP COSTS for the patients who have insurance. I told them I was not going to play any more, and refuse to pay them one more cent. I made an offer of $1080 to settle, they sent my check back. Sorry, that was the last and BEST offer. They can screw somebody else, but I am finished. The Chief Financial Officer of HMA, the parent corporation makes over $1 Million a year. Is that right? Care should take care of the PATIENT, not the STOCKHOLDER.
regards
Bob

I am confused why you feel that informed consent is an issue. Since you are a "licensed medical professional," who openly proclaims knowing a great deal about your own situation and criticizing the work of those professionals who were treating you, one can only assume that you are already adequately "informed" through your own experience and medical training. Is this not correct?

emedicine.com says of renal colic:

'Acute renal colic is probably the most excruciatingly painful event a person can endure. Striking without warning, the pain is often described as being worse than childbirth, broken bones, gunshot wounds, burns, or surgery. Renal colic affects approximately 1.2 million people each year and accounts for approximately 1% of all hospital admissions. Most active emergency departments (EDs) treat an average of at least one patient with acute renal colic every day depending on the hospital's patient population. The ED physician is often the first to see and evaluate these patients. While proper diagnosis, prompt initial treatment, and appropriate consultations are clearly the primary responsibility of the emergency physician, substantial patient education, including preventive therapy program options, should also be started in the ED.'

Someone in this much pain can hardly even be held accountable for signatures on treatment forms at an Emergency room.

What is 'Informed Consent?' This is what I did not have, since no alternatives were offered, nor were costs of the investigations discussed or even mentioned. Ethical topics in Medicine says:
'
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

What are the elements of full informed consent?
The most important goal of informed consent is that the patient have an opportunity to be an informed participant in his health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:

* the nature of the decision/procedure
* reasonable alternatives to the proposed intervention
* the relevant risks, benefits, and uncertainties related to each alternative
* assessment of patient understanding
* the acceptance of the intervention by the patient

In order for the patient's consent to be valid, he must be considered competent to make the decision at hand and his consent must be voluntary. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. To encourage voluntariness, the physician can make clear to the patient that he is participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation to him to participate in his health care decisions. The physician is also generally obligated to provide a recommendation and share her reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. Consequently, the discussion should be carried on in layperson's terms and the patient's understanding should be assessed along the way.

Basic consent entails letting the patient know what you would like to do and asking them if that will be all right. Basic consent is appropriate, for example, when drawing blood. Decisions that merit this sort of basic informed consent process require a low-level of patient involvement because there is a high-level of community consensus.

How much information is considered 'adequate'?
How do you know when you have said enough about a certain decision? Most of the literature and law in this area suggest one of three approaches:

* reasonable physician standard: what would a typical physician say about this intervention? This standard allows the physician to determine what information is appropriate to disclose. However, it is probably not enough, since most research in this area shows that the typical physician tells the patient very little. This standard is also generally considered inconsistent with the goals of informed consent as the focus is on the physician rather than on what the patient needs to know.
* reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.
* subjective standard: what would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient.

Most states have legislation or legal cases that determine the required standard for informed consent. In the state of Washington, we use the 'reasonable patient standard.' The best approach to the question of how much information is enough is one that meets both your professional obligation to provide the best care and respects the patient as a person with the right to a voice in health care decisions. (See also Truth-Telling and Law and Medicine.)

What sorts of interventions require informed consent?
Most health care institutions, including UWMC, Harborview, and VAMC have policies that state which health interventions require a signed consent form. For example, surgery, anesthesia, and other invasive procedures are usually in this category. These signed forms are really the culmination of a dialogue required to foster the patient's informed participation in the clinical decision.

For a wide range of decisions, written consent is neither required or needed, but some meaningful discussion is needed. For instance, a man contemplating having a prostate-specific antigen screen for prostate cancer should know the relevant arguments for and against this screening test, discussed in layman's terms. (See also Research Ethics.) '

emedicine.com says of renal colic:

'Acute renal colic is probably the most excruciatingly painful event a person can endure. Striking without warning, the pain is often described as being worse than childbirth, broken bones, gunshot wounds, burns, or surgery. Renal colic affects approximately 1.2 million people each year and accounts for approximately 1% of all hospital admissions. Most active emergency departments (EDs) treat an average of at least one patient with acute renal colic every day depending on the hospital's patient population. The ED physician is often the first to see and evaluate these patients. While proper diagnosis, prompt initial treatment, and appropriate consultations are clearly the primary responsibility of the emergency physician, substantial patient education, including preventive therapy program options, should also be started in the ED.'

Someone in this much pain can hardly even be held accountable for signatures on treatment forms at an Emergency room.

What is 'Informed Consent?' This is what I did not have, since no alternatives were offered, nor were costs of the investigations discussed or even mentioned. Ethical topics in Medicine says:
'
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

What are the elements of full informed consent?
The most important goal of informed consent is that the patient have an opportunity to be an informed participant in his health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:

* the nature of the decision/procedure
* reasonable alternatives to the proposed intervention
* the relevant risks, benefits, and uncertainties related to each alternative
* assessment of patient understanding
* the acceptance of the intervention by the patient

In order for the patient's consent to be valid, he must be considered competent to make the decision at hand and his consent must be voluntary. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. To encourage voluntariness, the physician can make clear to the patient that he is participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation to him to participate in his health care decisions. The physician is also generally obligated to provide a recommendation and share her reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. Consequently, the discussion should be carried on in layperson's terms and the patient's understanding should be assessed along the way.

Basic consent entails letting the patient know what you would like to do and asking them if that will be all right. Basic consent is appropriate, for example, when drawing blood. Decisions that merit this sort of basic informed consent process require a low-level of patient involvement because there is a high-level of community consensus.

How much information is considered 'adequate'?
How do you know when you have said enough about a certain decision? Most of the literature and law in this area suggest one of three approaches:

* reasonable physician standard: what would a typical physician say about this intervention? This standard allows the physician to determine what information is appropriate to disclose. However, it is probably not enough, since most research in this area shows that the typical physician tells the patient very little. This standard is also generally considered inconsistent with the goals of informed consent as the focus is on the physician rather than on what the patient needs to know.
* reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.
* subjective standard: what would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient.

Most states have legislation or legal cases that determine the required standard for informed consent. In the state of Washington, we use the 'reasonable patient standard.' The best approach to the question of how much information is enough is one that meets both your professional obligation to provide the best care and respects the patient as a person with the right to a voice in health care decisions. (See also Truth-Telling and Law and Medicine.)

What sorts of interventions require informed consent?
Most health care institutions, including UWMC, Harborview, and VAMC have policies that state which health interventions require a signed consent form. For example, surgery, anesthesia, and other invasive procedures are usually in this category. These signed forms are really the culmination of a dialogue required to foster the patient's informed participation in the clinical decision.

For a wide range of decisions, written consent is neither required or needed, but some meaningful discussion is needed. For instance, a man contemplating having a prostate-specific antigen screen for prostate cancer should know the relevant arguments for and against this screening test, discussed in layman's terms. (See also Research Ethics.) '

emedicine.com says of renal colic:

'Acute renal colic is probably the most excruciatingly painful event a person can endure. Striking without warning, the pain is often described as being worse than childbirth, broken bones, gunshot wounds, burns, or surgery. Renal colic affects approximately 1.2 million people each year and accounts for approximately 1% of all hospital admissions. Most active emergency departments (EDs) treat an average of at least one patient with acute renal colic every day depending on the hospital's patient population. The ED physician is often the first to see and evaluate these patients. While proper diagnosis, prompt initial treatment, and appropriate consultations are clearly the primary responsibility of the emergency physician, substantial patient education, including preventive therapy program options, should also be started in the ED.'

Someone in this much pain can hardly even be held accountable for signatures on treatment forms at an Emergency room.

What is 'Informed Consent?' This is what I did not have, since no alternatives were offered, nor were costs of the investigations discussed or even mentioned. Ethical topics in Medicine says:
'
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

What are the elements of full informed consent?
The most important goal of informed consent is that the patient have an opportunity to be an informed participant in his health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:

* the nature of the decision/procedure
* reasonable alternatives to the proposed intervention
* the relevant risks, benefits, and uncertainties related to each alternative
* assessment of patient understanding
* the acceptance of the intervention by the patient

In order for the patient's consent to be valid, he must be considered competent to make the decision at hand and his consent must be voluntary. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. To encourage voluntariness, the physician can make clear to the patient that he is participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation to him to participate in his health care decisions. The physician is also generally obligated to provide a recommendation and share her reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. Consequently, the discussion should be carried on in layperson's terms and the patient's understanding should be assessed along the way.

Basic consent entails letting the patient know what you would like to do and asking them if that will be all right. Basic consent is appropriate, for example, when drawing blood. Decisions that merit this sort of basic informed consent process require a low-level of patient involvement because there is a high-level of community consensus.

How much information is considered 'adequate'?
How do you know when you have said enough about a certain decision? Most of the literature and law in this area suggest one of three approaches:

* reasonable physician standard: what would a typical physician say about this intervention? This standard allows the physician to determine what information is appropriate to disclose. However, it is probably not enough, since most research in this area shows that the typical physician tells the patient very little. This standard is also generally considered inconsistent with the goals of informed consent as the focus is on the physician rather than on what the patient needs to know.
* reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.
* subjective standard: what would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient.

Most states have legislation or legal cases that determine the required standard for informed consent. In the state of Washington, we use the 'reasonable patient standard.' The best approach to the question of how much information is enough is one that meets both your professional obligation to provide the best care and respects the patient as a person with the right to a voice in health care decisions. (See also Truth-Telling and Law and Medicine.)

What sorts of interventions require informed consent?
Most health care institutions, including UWMC, Harborview, and VAMC have policies that state which health interventions require a signed consent form. For example, surgery, anesthesia, and other invasive procedures are usually in this category. These signed forms are really the culmination of a dialogue required to foster the patient's informed participation in the clinical decision.

For a wide range of decisions, written consent is neither required or needed, but some meaningful discussion is needed. For instance, a man contemplating having a prostate-specific antigen screen for prostate cancer should know the relevant arguments for and against this screening test, discussed in layman's terms. (See also Research Ethics.) '

emedicine.com says of renal colic:

'Acute renal colic is probably the most excruciatingly painful event a person can endure. Striking without warning, the pain is often described as being worse than childbirth, broken bones, gunshot wounds, burns, or surgery. Renal colic affects approximately 1.2 million people each year and accounts for approximately 1% of all hospital admissions. Most active emergency departments (EDs) treat an average of at least one patient with acute renal colic every day depending on the hospital's patient population. The ED physician is often the first to see and evaluate these patients. While proper diagnosis, prompt initial treatment, and appropriate consultations are clearly the primary responsibility of the emergency physician, substantial patient education, including preventive therapy program options, should also be started in the ED.'

Someone in this much pain can hardly even be held accountable for signatures on treatment forms at an Emergency room.

What is 'Informed Consent?' This is what I did not have, since no alternatives were offered, nor were costs of the investigations discussed or even mentioned. Ethical topics in Medicine says:
'
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

What are the elements of full informed consent?
The most important goal of informed consent is that the patient have an opportunity to be an informed participant in his health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:

* the nature of the decision/procedure
* reasonable alternatives to the proposed intervention
* the relevant risks, benefits, and uncertainties related to each alternative
* assessment of patient understanding
* the acceptance of the intervention by the patient

In order for the patient's consent to be valid, he must be considered competent to make the decision at hand and his consent must be voluntary. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. To encourage voluntariness, the physician can make clear to the patient that he is participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation to him to participate in his health care decisions. The physician is also generally obligated to provide a recommendation and share her reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. Consequently, the discussion should be carried on in layperson's terms and the patient's understanding should be assessed along the way.

Basic consent entails letting the patient know what you would like to do and asking them if that will be all right. Basic consent is appropriate, for example, when drawing blood. Decisions that merit this sort of basic informed consent process require a low-level of patient involvement because there is a high-level of community consensus.

How much information is considered 'adequate'?
How do you know when you have said enough about a certain decision? Most of the literature and law in this area suggest one of three approaches:

* reasonable physician standard: what would a typical physician say about this intervention? This standard allows the physician to determine what information is appropriate to disclose. However, it is probably not enough, since most research in this area shows that the typical physician tells the patient very little. This standard is also generally considered inconsistent with the goals of informed consent as the focus is on the physician rather than on what the patient needs to know.
* reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.
* subjective standard: what would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient.

Most states have legislation or legal cases that determine the required standard for informed consent. In the state of Washington, we use the 'reasonable patient standard.' The best approach to the question of how much information is enough is one that meets both your professional obligation to provide the best care and respects the patient as a person with the right to a voice in health care decisions. (See also Truth-Telling and Law and Medicine.)

What sorts of interventions require informed consent?
Most health care institutions, including UWMC, Harborview, and VAMC have policies that state which health interventions require a signed consent form. For example, surgery, anesthesia, and other invasive procedures are usually in this category. These signed forms are really the culmination of a dialogue required to foster the patient's informed participation in the clinical decision.

For a wide range of decisions, written consent is neither required or needed, but some meaningful discussion is needed. For instance, a man contemplating having a prostate-specific antigen screen for prostate cancer should know the relevant arguments for and against this screening test, discussed in layman's terms. (See also Research Ethics.) '

http://www.emedicine.com says of renal colic:

"Acute renal colic is probably the most excruciatingly painful event a person can endure. Striking without warning, the pain is often described as being worse than childbirth, broken bones, gunshot wounds, burns, or surgery. Renal colic affects approximately 1.2 million people each year and accounts for approximately 1% of all hospital admissions. Most active emergency departments (EDs) treat an average of at least one patient with acute renal colic every day depending on the hospital's patient population. The ED physician is often the first to see and evaluate these patients. While proper diagnosis, prompt initial treatment, and appropriate consultations are clearly the primary responsibility of the emergency physician, substantial patient education, including preventive therapy program options, should also be started in the ED."

Someone in this much pain can hardly even be held accountable for signatures on treatment forms at an Emergency room.

What is "Informed Consent?" This is what I did not have, since no alternatives were offered, nor were costs of the investigations discussed or even mentioned. Ethical topics in Medicine says:
"
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

What are the elements of full informed consent?
The most important goal of informed consent is that the patient have an opportunity to be an informed participant in his health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:

* the nature of the decision/procedure
* reasonable alternatives to the proposed intervention
* the relevant risks, benefits, and uncertainties related to each alternative
* assessment of patient understanding
* the acceptance of the intervention by the patient

In order for the patient's consent to be valid, he must be considered competent to make the decision at hand and his consent must be voluntary. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. To encourage voluntariness, the physician can make clear to the patient that he is participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation to him to participate in his health care decisions. The physician is also generally obligated to provide a recommendation and share her reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. Consequently, the discussion should be carried on in layperson's terms and the patient's understanding should be assessed along the way.

Basic consent entails letting the patient know what you would like to do and asking them if that will be all right. Basic consent is appropriate, for example, when drawing blood. Decisions that merit this sort of basic informed consent process require a low-level of patient involvement because there is a high-level of community consensus.

How much information is considered "adequate"?
How do you know when you have said enough about a certain decision? Most of the literature and law in this area suggest one of three approaches:

* reasonable physician standard: what would a typical physician say about this intervention? This standard allows the physician to determine what information is appropriate to disclose. However, it is probably not enough, since most research in this area shows that the typical physician tells the patient very little. This standard is also generally considered inconsistent with the goals of informed consent as the focus is on the physician rather than on what the patient needs to know.
* reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.
* subjective standard: what would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient.

Most states have legislation or legal cases that determine the required standard for informed consent. In the state of Washington, we use the "reasonable patient standard." The best approach to the question of how much information is enough is one that meets both your professional obligation to provide the best care and respects the patient as a person with the right to a voice in health care decisions. (See also Truth-Telling and Law and Medicine.)

What sorts of interventions require informed consent?
Most health care institutions, including UWMC, Harborview, and VAMC have policies that state which health interventions require a signed consent form. For example, surgery, anesthesia, and other invasive procedures are usually in this category. These signed forms are really the culmination of a dialogue required to foster the patient's informed participation in the clinical decision.

For a wide range of decisions, written consent is neither required or needed, but some meaningful discussion is needed. For instance, a man contemplating having a prostate-specific antigen screen for prostate cancer should know the relevant arguments for and against this screening test, discussed in layman's terms. (See also Research Ethics.) "