Chapter 11: Patient Education and Informed Consent

INTRODUCTION

A good outcome means both a good medical response to therapy and a satisfied patient. Patient satisfaction depends not so much on the technical success of the procedure as it does on the expectations held by the patient before the procedure. The best way to ensure a good outcome is to make sure that the expectations of the patient and the doctor are the same before beginning any treatment.

Patient education is an important first step. There are risks associated with every procedure and no procedure guarantees an excellent medical outcome every time. The patient must understand that medicine is not an exact science and that there is no guarantee that he or she will be satisfied with the improvement in his or her varicose/spider veins after treatment. To ensure consistency, a list of standard topics for discussion should be adopted. Each topic should be explained carefully, preferably with pictures, in such a way that the patient is able to understand. Each patient must have ample opportunity to ask any questions and to receive complete answers. One should not proceed with treatment until one feels comfortable with the patient’s understanding and expectations. It is difficult to establish the appropriate physician–patient relationship with patients who are unreasonable, overly demanding, or unable to comprehend the basics. These types of patients are also the most likely to complain about any or all aspects of their treatment.

TOPICS FOR DISCUSSION

Typical topics for discussion include reasonable patient expectations, underlying causes of venous disease, the medical and cosmetic benefits of treatment, the risks of unsuccessful treatment or of complications, the types of treatments available and the alternatives to treatment, the reasons for requiring a complete examination with testing where indicated, the solutions that may be used in treatment and their potential side effects, and any temporary problems that may arise during the course of treatment and the healing phase (Table 11-1). Only after such a discussion can an informed consent document reasonably be signed.

Patient Expectations

The patient expectations are listed below:

1. Improvement of pain and other symptoms if caused by abnormal veins;

2. Complete closure of any particular vein to be treated;

3. Eighty percent clearing of overall areas treated for cosmetic reasons: no ...