Informed Consent, COVID, Med-Mal, and Being Humble

Informed Consent, COVID, Med-Mal, and Being Humble...that's a lot for one column.  And Happy New Year by the way! 

Walk with me. 

I thought a lot about this column after recovering from COVID during Christmas and being physically able to still go skiing over the holiday with my son.  Thank God for Paxlovid! 

My kids and I got the original COVID shots in 2020 and then a booster in early 2021, but hesitated on the booster this past fall (2022) given reports from credible medical voices (Makary et al) in traditional media and social media claiming that heart inflammation is a possible side effect for young people who are administered the COVID vaccine.  So, we didn't get the booster shot this fall, got sick and missed Christmas with family, but Paxlovid literally knocked down the disease in two days and life resumed. I felt like I made an informed choice, and shouldn't that be the first want or desire of all patients and families?  Shouldn't adequate and understandable informed consent be attainable whether we are talking about a vaccine, a surgery, or accepting or foregoing care related to a terminal condition?  

Over the last 19 years in my efforts at Sorry Works! I have often talked about informed consent and its role in the disclosure process. Often, my colleagues and I in the disclosure movement have stated that the disclosure process starts with unvarnished informed consent -- tell'em everything, including the scary stuff, and let the chips fall where they may.  "Sometimes the best surgery or procedure is the one doesn't happen" is something I have said numerous times.  Nonetheless, I'll never forget the surgeon in Oklahoma who explained that truthful informed consent might scare patients out of an operation and he wouldn't get his fee!  Medical paternalism mixed with a dose of profiteering (or capitalism if we are being nice) still means too many patients and families are never given their ethical due during the informed consent process. I believe COVID has further damaged the concept of informed consent and dramatically increased the distrust some patients and families feel towards the medical profession.  Too many doctors and public health professionals and their allied politicians played loose and fast with the facts -- or didn't deal in facts or data at all -- in making their COVID pronouncements and handing down edicts.   

There is now a constant trickle of articles and stories from very credible outlets such as the Wall Street Journal claiming potential side effects or unknowns about vaccines were suppressed to goose vaccine acceptance, and voices questioning or debating other popular COVID narratives were actively quashed by government officials.  On this Monday alone WSJ's editorial pages featured two op-eds on this topic.  Indeed, there are many people who had their trust in organized medicine tested and even violated during the pandemic.  Moreover, I firmly believe that our COVID experience gave many Americans a perspective or understanding of why so many African Americans mistrust medicine.   If you lie, don't share all the facts or data, and play games with us we will not trust you, no matter our skin color.  

Now, how does this column tie in with med-mal?  We all know that for far too long medical professionals and the insurance and legal professionals assisting them have actively lied about substandard healthcare, including painfully obvious cases of medical malpractice.  It's called deny and defend.  It's also called evil. At Sorry Works we have argued that all those years of deny and defend created the expensive problem of non-meritorious -- or frivolous -- medical malpractice litigation.  When physicians are known to be liars, trust from patients and families is in short supply, every bad outcome automatically leads to suspicion of medical errors (no matter what the doctor says), and every claim (even the most specious claims) will be given an audience because the doctors have lied about everything else.

What is the way forward in our New Year?  Let’s start with “sorry.”  And these should not be difficult or expensive apologies complete with checks and other remediation.  But, instead, an acknowledgement that wrong was done in the name of trying to do right during the pandemic is sorely needed.  As an Illinois resident, I will never forget the spectacle of our morbidly obese governor waving his chubby index finger at parents like me and exclaiming if we allowed to children play sports in Fall 2020 we were risking their lives. I ignored the governor's fear mongering and took my son's baseball team across the river to St. Louis, Missouri numerous times that fall to play baseball and it was absolutely the right thing to do. Many others did the same, but countless kids had their high school and club sports seasons and even careers --- along with their mental health -- ruined due to Governor Pritzker's know-it-all arrogance.  Pritzker has never said "sorry," nor have there been apologies from any of the countless government or medical officials in this state or any other state who got COVID wrong and inflicted massive damage on our society, especially our youth.  They should try "I'm sorry" to receive forgiveness and take that first step to rebuilding trust in public health. 

Going forward, medical professionals need to tell the truth, especially during informed consent and after something goes wrong.  Tell us the good, the bad, and, most importantly, want you don't know about a vaccine or procedure.  Let us make up own minds. Autonomy is a big deal in Western Healthcare.  It is not your job to be a nanny, and even though less nannying might mean a little less revenue, physicians will still live nice life styles.  Just tell us the truth, share knowledge deficiencies, and say sorry when you screw up or do wrong.  In short, medicine and public health needs to be humbler.    

Sincerely,

- Doug

Doug Wojcieszak, Founder and President,
Sorry Works!
618-559-8168 (direct dial)
doug@sorryworks.net