Informed consent to medical testing and treatment is a concept deeply embedded in the law and the code of medical ethics. Health care providers are required to explain the risks, benefits, and alternatives to proposed testing and treatment protocols (Cleveland Clinic, 2024). But patients often feel at a psychological disadvantage when confronting health care ‘experts’ about their own health care decisions. The complexity of modern medicine can be daunting to those without specialized training. How are patients to know what questions to ask? And how can they be sure they understand the answers? In other words, as a foundational question in medicine, how can we know that a patient giving consent to a test or procedure fully understands what they are consenting to?
When a patient enters a medical clinic, they are typically confronted with a barrage of questions about insurance, medical history, and symptoms before they set foot past the receptionist. When they get to the exam room, they meet a medical assistant asking many of the same questions. When they finally see a doctor or physician’s assistant, the process continues with many of the same questions. Repetition can help ensure accuracy and focus treatment options. But undoubtedly, much of this is driven by insurance requirements. From the patient’s point of view, this is hardly a confidence building experience.
Many healthcare professionals now use artificial intelligence (AI) as a tool in diagnosis and decision making. These are the same AI sites where patients can also research reputable medical sources and seek second opinions. AI can also be helpful in checking provider credentials and locating patient reviews.
I want to offer a few remarks about some commonly used diagnostic tools whose risks are not always understood by patients. Computed tomography (CT) scans provide detailed, three dimensional images of internal organs and tissues. They can be invaluable in emergencies and critical diagnostic situations. But they expose patients to high levels of radiation and may be over utilized (National Institute Of Health, 2025, April). They have been linked to up to 5% of new cancer diagnoses in the United States with lung, colon, abdominal and pelvic cancers particularly prevalent.
Magnetic Resonance Imaging (MRI) scans also provide images of internal organs and tissues and are generally considered safer. But a 2018 study by the FDA reported that chemical agents used in the process remain in the body, including the brain, for extended periods and are not expelled as quickly as once believed. Serious side effects involving kidneys and other organs have been reported. This is not fearmongering. The benefits of MRI may outweigh the risks. But any reasonable definition of ‘informed consent’ requires that the risks and benefits are carefully weighed.
Colonoscopies for cancer screening is another procedure that has been increasingly emphasized in preventive care. However, this procedure is not without potential risks and side effects involving sedation, the destruction of flora needed for digestion, and dehydration. There are other less invasive alternatives not always discussed with patients.
The most important empowerment any individual can have is to remember that you remain in charge of your body. You are your own best advocate. Become informed and offer consent only when you have done your due diligence. Medical testing can be lifesaving, especially when ruling out serious or life-threatening conditions. At the same time, unnecessary testing can contribute to anxiety, financial burden and even additional medical risk. Patients should feel empowered to:
- Ask questions
- Request clarification
- Seek a second opinion
- Discuss alternatives
- Decline unwanted procedures
Healthcare decisions should be collaborative, not automatic. The principal of ‘my body, my choice’ applies to medical treatment as well as testing. The best medical outcomes will be achieved when you are an active participant in the decision making process. Informed consent depends on asking the right questions, understanding the options, and weighing the risks and benefits. Understanding your rights as a patient is liberating. No one can do this better than you can do it for yourself.
References
Cleveland Clinic (2024) Informed Consent: Medically Reviewed. Last updated on 12/01/2024.
https://my.clevelandclinic.org/health/articles/24268-informed-consent
National Institutes of Health. April 29, 2025. Radiation from CT scans and cancer risks
https://www.nih.gov/news-events/nih-research-matters/radiation-ct-scans-cancer-risks
Haederle, M. (2025, April) UNM Scientists Discover How Nanoparticles of Toxic Metal Used in MRI Scans Infiltrate Human Tissue
U.S. Food and Drug Administration (2018) FDA Drug Safety Communication: FDA warns that gadolinium-based contrast agents (GBCAs) are retained in the body; requires new class warnings
3 thoughts on “Informed Consent – Jill Keller, Ph.D.”
Asking the Big Question, how do physicians know if the patient’s level of understanding reaches the level of truly ‘informed consent’?
There is a lot of litigation around this issue. Physicians know that they are dealing with lay people who may be under tremendous stress. That’s why there is repetition and layers to the process.
Thank you for running this article. Honest physicians are never offended by patient questions.
As the former administrator of a major health care clinic in Chicago, now retired, I can tell you the issue of patient understanding in evaluating informed consent is second only to insurance issues as a barrier to care.
Jill Keller is right to point out the over use to CT and even colonoscopies. We have an insurance driven health care system.
Is it any wonder that in spite of the miracles of modern medicine, longevity in the United States is going down and not up?
So much of today’s medicine feels like being plugged into an assembly line. Back in the day, you went to a doctor that you probably knew well. He or she actually talked to you in order to understand your symptoms, examined you, and came up with a personalized plan to aid in your recovery. These Doctors were not afraid to spend enough time to make sure you understand their diagnoses, what they were treating you for, and answer your questions. All of their treatments were custom tailored to their individual patients.
Now days, when you go into a doctor’s office, you answer the questioner provided by the front office, and then see a medical tech that writes down your complaint and does a few simple tests like blood pressure, weight, pulse rate, and temperature. After that, the Doctor, Nurse Practitioner, or P.A comes in and offers you a diagnosis. In most cases, they make no attempt to examine you, they just write you a script, order further tests if necessary, give you brief instructions on how to take your medicine, and send you on your way. Heaven forbid if they have to answer any questions or explain their treatment. It’s obvious that your condition is being plugged into a flowchart and you are receiving the exact same treatment as every other patient with a similar complaint. Is seems as if personalized medicine is a thing of the past in today’s medical community.
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