In my experience as a IME physician, it is rare that I am asked for an opinion about “Informed Consent.” Occasionally an insurance adjuster might ask if the claimant is aware of the nature of the procedure that has been proposed. Although discussion of Informed Consent may not be part of an IME report, it is important for both the claimant and the insurance company to understand the elements necessary to make an informed consent.
The basic elements are:
- The ability and capacity for the patient to make a medical decision.
- An understanding of the proposed procedure, its benefits and risks, alternatives, as well as its anticipated outcome .
When discussing a proposed procedure during an IME exam, I often sense that the claimant has an unrealistic expectation of the outcome. We have an injury, and after non-surgical or non-interventional procedures have failed, we just want to move onto the next step. At this point it is critical that we understand what can be expected if everything turns out just right and what might happen if the procedure fails. If we are having a shoulder repair, such as a rotator cuff repair, is it reasonable that we will be able to return to a job that requires overhead lifting? Of course the answer will be dependent on many factors including our age, the extent of the tear and the quality of the torn tissue. It is always best if these discussions occur before the proposed procedure but many times the full understanding of the extent of injury will not be known until the procedure has been completed. Nonetheless, setting reasonable expectations is best for all involved parties.