Study: How informed is too informed?

In a survey of more than 380 patients, nearly 80% said that they believe a surgeon's experience is essential information that patients need to make an informed decision about elective surgery.

The results of a survey that was presented at the 2011 Clinical Congress of the American College of Surgeons suggests that surgeons do have an ethical obligation to disclose information about their experience during informed consent discussions. The study authors have further supposed that disclosure one day might be legally mandated in some jurisdictions.

Lead author of the study, Susan J. Lee Char, MD, JD, a lawyer and general surgery resident at the University of California San Francisco, said that if patients think they need to know about a surgeon's volumes and outcomes, then surgeons need to provide them that information. "That information should include their own volumes and outcomes if accurate data are available, and whether it would be their first time performing the procedure," she said.

The study highlights the enduring debate in surgery about whether surgeons should be required to disclose their volumes and outcomes when obtaining informed consent.

In half of U.S. states, courts use a "reasonable physician standard" as the basis for their decisions on what type of disclosure is necessary, meaning that information should be included if a reasonable physician believes it is relevant for a patient deciding whether to have surgery. The other half of U.S. states uses a reasonable patient standard to determine what is relevant.

The investigators surveyed 383 patients and 85 surgeons from the University of California-San Francisco and affiliated hospitals. The patients, who had already undergone surgery at the university, were asked to answer two questions: What types of information about volumes and outcomes are essential to patients deciding whether to have surgery? How do patients and surgeons differ on what information is important during the informed consent process?

Results proved that the most important piece of information was if the surgeon would be performing the surgery for the first time. Eighty percent of patients considered this information essential to decision making.

The results also showed that surgeons thought that their volumes/outcomes and their previous number of cases were not as relevant to the informed consent process as discussion of risks and benefits.