The age of consent tools
By John Pulley
Like many students who attended the University of California at Berkeley in the 1960s, Dr. James Gottesman fell under the spell of radical ideas. But unlike most of his peers, the undergraduate math major became enamored of the revolution in computers, which at the time “occupied buildings the size of the Pentagon,” he said.
However, within a few years, the call of medicine had taken Gottesman away from his love of programming. The man and the avocation were estranged until medical malpractice emerged as a troublesome issue.
Frustrated by the laborious reporting requirements hospitals were adopting to limit liability, Gottesman sat down at his new Apple II, the first mass-produced microcomputer, and created what is believed to be the first electronic medical consent form. Stored on a floppy disk, the program sought to reduce paperwork and promote more meaningful conversations between doctors and patients.
A quarter-century later, the mainstream medical community is catching up to Gottesman. Physicians are adopting new technology to improve the informed-consent process. And there is a “renewed emphasis on informed consent by health care regulators,” said Jeffrey Driver, chief risk officer at Stanford University Medical Center.
The Defense and Veterans Affairs departments, which train a large percentage of the country’s doctors, are also driving the adoption of informed-consent technology. Gottesman, who practices medicine in Washington state, predicts that the involvement of large government programs will lead to a standard for obtaining and documenting informed consent.
“We have standards for almost everything in health care, but for consenting, there are none,” he said.
Personal rights
In 1914, nearly two decades before he was named to the U.S. Supreme Court, Judge Benjamin Cardoza ruled that “every human being of adult years and sound mind has the right to determine what shall be done with his body, and a surgeon who performed an operation without his patient’s consent commits an assault for which he is liable for damages.”
But in the intervening decades, the health care system has failed to consistently inform patients of critical information, including risks and alternative treatments, before performing surgery and other medical interventions. VA officials recently conducted a review of the literature and found that fewer than half the patients studied fully understood the procedures their doctors recommended. And documentation of those exchanges has often been missing.