Trust Me I’M A Doctor…. Working towards a Healthy Prescriptive Consent According to Decision Theory by David J John O Regan in BJSTR
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.
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