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The New Medical Consent

There is a very interesting piece in the Wall Street Journal on hospitals’ efforts to assure that their patients understand the consent forms they are signing. Here is a description of the VA’s efforts:

The Department of Veteran’s Affairs, with 153 hospitals, has over the past several years adopted a new electronic informed-consent software program that allows patients to use a digital pad to sign the consent forms, which can then be stored in their medical record. The program, known as iMedConsent, includes a library of anatomical diagrams and explanations written at a sixth-grade reading level for more than 2,000 procedures in more than 30 medical specialties.

This is a laudable effort to use computer technology to make new (and old) medical technologies accessible. Certainly a lot more needs to be done on this front. . . .

For example, Henry Aaron highlights how little medical professionals know about the value of many of the technologies they employ:

U.S. analysts have suggested a six-level framework with which to evaluate improved technology such as diagnostic imaging. First, does the test perform as intended in a physical sense? For example, can a newer CT scanner distinguish tumor from normal tissue more effectively than an older model did? The second level of evaluation refers to diagnostic accuracy: is the test sensitive and specific? For example, does a stress test accurately show heart disease when it is present and clearly indicate its absence when it is not? Third, does the test alter the clinician’s diagnosis? When simple methods work, sophisticated techniques may add nothing but cost. Fourth, does the test affect the patient’s treatment? Accurately diagnosing a condition for which no effective treatment is available has little value. Fifth, do the test and associated changes in treatment improve patient health? Finally, what are the social consequences of the test as measured, for example, by cost effectiveness when compared to another procedure?

This six-level framework for evaluation is based on methods applied in the U.S. Agency for Healthcare Research and Quality as described by Athina Tatsioni et al., Challenges in Systematic Reviews of Diagnostic Technologies, 142 ANNALS OF INTERNAL MED. 1048, 1048 (2005).

Level-one and level-two evaluations are most common. A count of studies of magnetic resonance spectroscopy for brain tumors through 2004 revealed eighty-five level-one studies and eight level-two studies had been performed, but only two level-three studies, two level-four studies, and no level-five or level-six studies. Yet it is level-five and level-six studies that are most relevant for decisions of any group, private or public, responsible for administering limited health resources…

…as well as to patients deciding on whether to consent.