Can a physician delegate the informed consent process?


Dr KK Aggarwal    06 January 2018

  • Surgeons and medical interventionalists are at high risk for work-related musculoskeletal disorders, with rates comparable to construction workers, according to a systematic review and meta-analysis published online December 27 in JAMA Surgery. Pooled crude prevalence estimates showed that the most common work-related musculoskeletal disorder was degenerative lumbar spine disease, with an overall career prevalence of 19% (95% confidence interval [CI], 13% - 27%).
  • Modifiable biologic, neighborhood, psychosocial, socioeconomic, and behavioral risk factors may explain most of the approximately two-fold higher risk of developing type 2 diabetes in blacks vs whites, researchers report in the December 26 issue of the Journal of the American Medical Association.
  • Can a physician delegate the informed consent process? Except for in emergencies, physicians must discuss with patients the benefits, risks, and alternatives to any proposed surgical procedure before they can operate. This process also includes many nonsurgical treatments, such as blood transfusions, colonoscopies, cancer treatments, and comprehensive medical regimens. A number of physicians have begun to delegate all or part of the informed consent process to a nonphysician clinician, such as a nurse practitioner (NP) or physician assistant (PA). Is this an acceptable practice?

Court rules informed consent cannot be delegated. That was the key question in a controversial case recently decided by the Pennsylvania Supreme Court. In a 4-3 ruling, the court held that informed consent requires "direct communication between physician and patient, and contemplates a back-and-forth exchange. ... The duty to obtain informed consent belongs solely to the physician and cannot be delegated." The court held that a physician cannot rely upon a subordinate to disclose vital information and obtain informed consent.

  • Dental antibiotics prescriptions often overlooked: When looking for a potential cause of community-acquired Clostridium difficile infection, dental prescribing is one of the reasons. A report developed in partnership between the Emerging Infections Program at the Centers for Disease Control and Prevention and state health departments found that upward of 15% of patients with community-acquired CDI who reported taking antibiotics were prescribed the drugs by their dentist within the 12 weeks before illness. The report also noted that dentists routinely prescribe antibiotics to their patients without follow-up. In 2013, dentists wrote prescriptions for a staggering 24.5 million courses of antibiotics, or 77.5 prescriptions per 1000 people. This accounts for approximately 10% of all antibiotic prescriptions in the outpatient setting. (Medscape)
  • Getting up and out of your seat every 30 minutes could help to reduce heart disease. Adults in the United States spend more than 12 hours per day sitting down, and the more time spent sitting, the greater their risk of premature death from all causes will be. Getting up and moving around every half an hour could help to reduce the harms of prolonged sitting, say Keith Diaz, Ph.D., of Columbia University Medical Center in New York City, NY, and colleagues, who recently published their findings in the Annals of Internal Medicine.
  • A CDC ban on fetus and transgender? Experts alarmed The health community was reacting to a story in The Washington Post published late Fridayciting an anonymous source who said the prohibition was made at a recent meeting of senior budget officials at the U.S. Centers for Disease Control and Prevention. The seven words and phrases - "diversity," entitlement," fetus," transgender," vulnerable," evidence-based" and "science-based" - were not to be used in documents that are to be circulated within the federal government and Congress in preparation of the next presidential budget proposal.
  • Radiation-induced DNA damage seen in interventional cardiologists: Two new studies show the potential risks interventional cardiologists face from occupational ionizing radiation exposure published in December 19, 2017 in Circulation. Lower leg shielding "should be standard."  A recent global survey of radiation protection measures used by vascular interventionists found that only 40% used leg lead protection.
  • Early-onset type 2 diabetes is not a benign condition, says a study published December 11 in Diabetes/Metabolism Research and Reviews. Younger adults who were newly diagnosed with type 2 diabetes are more likely to have cardiovascular disease risk factors like severe obesity, hyperlipidemia, low-grade inflammation, physical inactivity, and smoking — compared with adults who developed diabetes later in life, in a national study in Denmark. The prevalence of these CVD risk factors was highest in patients with early-onset diabetes (age 18 to 45) and decreased stepwise as the age of diabetes diagnosis increased.
  • Being married prolongs life. In a large study of patients with coronary artery disease those who were widowed, divorced/separated, or never married were more likely to die from cardiovascular causes or have a nonfatal MI than married patients over a period of about 4 years. The study is published in December 20 in the Journal of the American Heart Association.
  • Seventeen people across 13 states, including one person in New York, have been affected by an E. coli diarrhea outbreak, according to the CDC.


Dr KK Aggarwal


Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

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