OVERKILL? Is our informed consent process a bit much?

Honesty is the best policy. I'm a big believer in that. So, yes, we should apprise patents who elect to have surgery of the pros and cons of each procedure. I do lament, however, that the consent process has degraded into a nitpicking, catastrophizing and excessively legalese document.

• Nitpicking. If I had a dime for every time I was called for an incomplete consent, I'd be in the Virgin Islands on the second tee … now. Common reasons for being reprimanded include:

❑ Failing to write out the words left and right. The letter 'l' no longer suffices and is grounds for a sharp reproof by the PACU nurse. Next thing you know I'll be forced to write out 'doctor kelly' instead of 'dr. k' Do I need to write 'exostosis' instead of 'spur'?

❑ Omitting the words 'acromioplasty' when consenting for rotator cuff repair. Ouch! I've been routinely performing acromioplasty with my standard cuff repairs for the past 23 years, so I feel dinged when I hear this. Should I also add 'excision of bursa?' Gimme a break!

❑ Omitting the phrase 'possible open' to an arthroscopic procedure. I've never opened a knee for a routine meniscectomy in my entire career, so I take umbrage to this criticism. Should I add 'injection of portals with lidocaine?'

• Catastrophizing. Again, the truth is always sacred, but I don't believe we should scare the living daylights out of our patients. Should we really include 'death, loss of limb or paralysis' to the consent for a removal of a prominent screw? Do we really need to add the phrase 'other unpredictable risks'? That could mean anything from lightning striking the OR to a hangover for the surgeon. Patients shouldn't need a Valium drip before a lipoma excision. We are healers and patient advocates, not tormentors of the soul.

• Legalese. I often joke that practicing in Philadelphia affords me the opportunity to be sued B.I.D. It's sad that we do so many things not in the best interests of patients, but merely in the spirit of defense against litigation. Phrases such as 'including but not limited to…' are normally not my first choice of words when discussing the reasonable risks of an operation with a patient. Does this include dengue fever? Not limited to coma? 'injury to nearby organs' would evoke fear in the most courageous of souls. By the way, what's the closest organ to a bunion? I've never liked the phrase 'likelihood of achieving the goals.' What am I, some surgical odds-maker? How does one define likelihood — does it mean probable, likely or bet the house on it?

In your best interest
I know some of these laments and sarcasm pertain to a necessary evil: Our society does not allow for a reasonable discussion about realistic risks and expectations. I do comply, to the best of my ability, with the informed consent process in order to avoid unnecessary heartache for both my staff and me. Truth is, I wish we could return to the days when I could simply say to each patient, "Every surgery has some risks, but I am here to help you. I believe this procedure is in your best interest."