Doctor-patient communication: An exploration of language use during the informed consent process

This study explored language use of doctors and patients while obtaining an informed consent; whether or not physicians covered the legal elements of informed consent during the conference; perceptions of doctors and patients of one another. The intent was to explore the process involved in determining the making of an ideal final product--a valid, well informed consent. This study was conducted at: an Organ Transplant Center, a unit in the teaching hospital of an eastern medical school; the private office of two plastic surgeons in the northeast. Informed consent conferences between 15 male patients and 5 male physicians were audio-taped. Immediately thereafter, patients and physicians were interviewed separately. Topics covered included: content of the conference; coverage of the legal elements of informed consent; perceptions of the doctors and the patients of one another. Problem statements were answered in a yes/no fashion. Thematic analysis of the data was completed to determine themes and categories stemming from the problem statements. Results. All 15 patients and 5 doctors accurately perceived the content of their consent conferences. Two physicians were unaware of the patients\u27 knowledge and understanding. One physician omitted from his conference four legal elements of informed consent. The remaining three physicians were aware of their patients\u27 knowledge and understanding. These three physicians displayed mechanisms by which they became aware of the patients\u27 levels of knowledge and understanding. Fourteen patients showed accurate knowledge and understanding of their medical situations and options. Thirteen patients indicated that the decision to accept or refuse treatment was theirs. Two patients changed decisions based on information disclosed by the physician. In two cases, it was not clear who made the decision. As a result of the data analysis, a model of informed consent was developed. This model, based on legal elements of informed consent, refined and combined areas in which physicians in the ideal conferences excelled. Suggestions were made to avoid areas which other physicians neglected and/or ignored. Implications. Streamlined process of informed consent; achievement of a better product; a model for teaching students of law, medicine, and allied health fields how to talk and listen to clients