Chapter 5 Breaking Informed Consent: Strategies for Risk Communication in Surgical Practice
Maria R Dahm [+]
Israel Berger [+]
This chapter examines risk communication strategies used to obtain informed consent in surgical consultations. Drawing on recordings of 37 interactions collected in the consulting rooms of a colorectal surgeon, two particular types of strategies are presented and discussed: 1) Set pieces used to relate risk information about more ‘routine’ procedures such as colonoscopies; 2) Breaking informed consent – a more unique strategy employed by the observed surgeon in more demanding situation such as the discussion of ‘big’, potentially life-changing surgeries. Particular attention will be given to breaking informed consent as a communication strategy that incorporates communicative features of breaking bad news into the information and consent process. This chapter argues that the communicative act of obtaining consent can in fact be modeled as a type of breaking bad news. By taking advantage of this overlap, the surgeon is able to draw from a wider range of communication resources to establish rapport and trust and to build a strong relationship with patients and their families ‘before the wheels fall off’. Implications for surgical training will be sketched.