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GUEST EDITORIAL
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 52-53

“PUT A SIGN HERE and PUT A SIGN THERE!” (obtaining informed consent is not so easy in this changed litigious world)


Director and Consultant Psychiatrist, Manasa Hospital, Rajamahendravaram, Andhra Pradesh, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Rama Reddy Karri
Manasa Hospital, Rajamahendravaram, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_42_18

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How to cite this article:
Karri RR. “PUT A SIGN HERE and PUT A SIGN THERE!” (obtaining informed consent is not so easy in this changed litigious world). Arch Ment Health 2018;19:52-3

How to cite this URL:
Karri RR. “PUT A SIGN HERE and PUT A SIGN THERE!” (obtaining informed consent is not so easy in this changed litigious world). Arch Ment Health [serial online] 2018 [cited 2019 Mar 25];19:52-3. Available from: http://www.amhonline.org/text.asp?2018/19/2/52/248893



The consumer is the king. He has the right to know what he is receiving. Psychiatric patients are given much higher status after the dawn of the new Mental Healthcare Act, 2017, than hitherto he was ever given. Inter alia, the patient has the right to know what the doctor thinks he is suffering from, the nature of the problem or illness, the nature of treatment, how it works, the pros and cons, and many related issues.

The concept of informed consent is the bridge between the concepts of patient's autonomy and the optimum health-care delivery. Informed consent focuses on how these issues interact with each other. The significant issue now is how health-care professionals should handle these concepts. Patients have their specific rights with regard to the health-care delivery, and the therapists should also be aware of, and they have to respect those rights. Patient's autonomy is one of the fundamental ethical principles of health care. It is the rights of the patient to determine his own health issues and decide on the roadmap. Patients have the rights for participation management and require to be involved in the decision-making process. Gone were the days, when the psychiatric patients were treated involuntarily up to 3 months “under special circumstances” clause repealed Mental Health Act of 1987.

Now, it is not so easy to get “supported admission” or extension of it. After the advent of Mental healthcare Act, 2017, there exist so many obstacles in the form of advance directives, nominated representatives, application, and approval from Mental Health Review Boards.

Whether the consent is obtained from patient or patient's nominated representative, they have to be given full information about the disorder, proposed treatment, its pros and cons, alternative modalities of treatments available, what happens if the treatment is not undertaken, etc., in the understandable language and native slang of the party. Courts insist that the informed consent should be obtained by treating physician only but not by a nurse.

The prospective patient can even issue an advance directive regarding his future treatments. The patient is not a mere passive signatory for the command of a hospital receptionist or nurse, “Put a signature here. Put a signature there!” However, he is the active conavigator in deciding the roadmap. Informed consent is not a new thing for the medical practice. However, it is needed to be strictly practiced in the modern litigious world. Gone are the days of a paternalistic model of doctor–patient relationship. Unlike for general medical patients, for psychiatric patients, it is not so easy to explain the “whole truth and nothing but the truth.” As an example, imagine explaining the nature of the illness and the proposed treatment to a person with conversion disorder.


  Old Style Top


“Madam, your chest pain is due to some nervous problem, for which we are experts. That is the reason why you are referred here by the cardiologist. I am prescribing these medicines (fluoxetine, clonazepam, and vitamins) for you which will rectify your nervous problem. In addition to the medicines, you are required to speak to our counseling psychologist so that you get some mental comfort, which will soothe your nerves.”

(Patient and relatives obey without questioning. The progress of the case mainly depends on the Doctor's charisma, the patient's faith or even mercy!).


  New Challenges Top


Q: “Which are the nerves affected responsible for this problem?”

Ans: “Indeed, no nerves are affected. It is only an expression. To tell you the truth you don't have any disease in your body. Everything is the creation of your mind.”

Q: “How are this fluoxetine and clonazepam going to make me alright?”

Ans: “In your case, these are dummy drugs for you, and indeed, these act like any other dummy substance.”

“Then, why fluoxetine and clonazepam and why not some other dummy drugs?”

Ans: “Because I am most familiar with prescribing these drugs.”

Q: “How does a dummy drug act on me?”

Ans: “You know, yours is not real chest pain. It is the creation of your mind. We are going to deceive your mind by giving dummy drugs and suggesting that these drugs work wonders. With the faith you have, you will come out of the problem.”

Q: “What alternative dummies are available in the world? Don't they work?”

Ans: “Yes, you can go to a homeopath; you can go to an exorcist, hypnotist, or priest. You may get relief if you have faith. Lastly, of course, if you don't go anywhere also, you may become alright, if your mind wishes it.”

To sum up, psychiatrists are required to adopt new skills to adapt to the new challenges.






 

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