Trust Me I’M A Doctor…. Working towards a Healthy Prescriptive Consent According to Decision Theory

David J John O Regan*

Received: September 20, 2017;   Published: September 26, 2017

DOI: 10.26717/BJSTR.2017.01.000393

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Abstract

The consent process is a complex relationship between rational cognitive thinking and emotional processes [1] (page 62) that can alter the choices that are being made and can shape probabilities of outcomes [2]. The patient or “lay person” is presented to the cardiac surgeon “expert” by means of a referral letter from a cardiologist who in turn saw the patient following referral from a General Practitioner. Both the patient and the surgeon have a general understanding of the need to act [3]. There is an expectation of surgery but the objectives and goals of surgery have not been defined. The consent process involves clarification of those objectives, exploration of alternatives and the addition of some structure to the decision process. This, however, is subject to natural biases or “heuristics” and especially subject to framing. I hope to explore these biases from the perspective of the patient ‘lay’ customer and the consultant surgeon or ‘expert’ and examine the consultation process using prospect theories. I hope to look beyond these heuristics and offer prescriptive alternatives that may go some way towards an ideal consent.

Abbreviations : CABG: Coronary artery bypass grafts; AHA: American Heart Association; MRSA: Methicillin Resistant Staph Aureus – “fleshing eating bug”

Introduction| The Ideal Consent| The Patient| The Consultant as the Expert| The Consultation| A Healthy Prescription| Conclusion| Appendix| References|