Academic OB/GYN

Today I saw a patient for a preoperative visit and went through the ritual of “informed consent” and the signing of the surgical permit.   We had decided to do a hysterectomy to treat her problematic fibroids, and she very much wanted to proceed.  Having discussed the alternatives, we now had to go through the legal ritual of the surgical consent.

As usual, I discussed what we could expect to gain from the hysterectomy.   There was a 100% chance that she would no longer have any bleeding, and a very strong chance that any pain that originated in her central pelvis would get entirely or mostly better.  Anemia that resulted from the bleeding would improve. Other symptoms, like urinary pressure and frequency, and lateralized pelvic pain, would likely improve though it is not as strong a likelihood as the other symptoms.

We also discussed the risks.   “You could have bleeding during the surgery, potentially enough to need a blood transfusion before or after surgery.  You could get a communicable disease from a blood transfusion.  You could develop a wound  infection or abscess, which sometimes is easy to treat and other times quite complicated.  Anything in the abdomen could be damaged during the surgery, such as the bowel, bladder, ureters (“which carry urine from the kidneys to the bladder” I always say), blood vessels, or other structures.  Anything damaged can be fixed at the time by myself or a consultant.  There is a possibility something could be damaged but we do not recognize it at the time, or that there is a delayed injury.  If this occurs you might need further surgery, antibiotics, or hospitalization.  Though extremely rare, you could die or be injured from an unforeseen surgical complication or complication of anesthesia.”

At this point she looked white as a sheet, as usual, and then I tempered with “but all of this is extremely unlikely, less than 1% of cases for major issues, and I have to explain it all for legal reasons.  I am well trained to do this surgery and will do my absolute best for you.”  I answered her questions, the consent is signed, and we had our pre-op.
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