by James D. Hundley, MD<\/p>\n
In days of yore, undertaker assistants were tasked with hanging crepe (black cloth) over the windows of homes of the deceased and were called \u201ccrepe hangers\u201d.\u00a0 Similarly, they laid crepe over the casket of the deceased.\u00a0 \u201cHanging crepe\u201d and \u201claying crepe\u201d have become euphemistic terms for extreme pessimism.<\/p>\n
Surgeons are castigated for \u201claying crepe\u201d with patients and their families before surgery when the formal operative consent is obtained.\u00a0 Critics claim this creates unnecessary fear in patients so that when the operation is successful the surgeon appears a hero or without fault if it\u2019s not.<\/p>\n
I disagree.\u00a0 It\u2019s neither about heroes nor about lawsuits.\u00a0 It\u2019s about \u201cinformed consent\u201d. \u00a0Patients deserve to know the bad as well as the good before they have an operation.\u00a0 Otherwise, how can they make informed decisions?<\/b><\/p>\n
A good friend of mine was recently discussing upcoming surgery on his infant grandson.\u00a0 The child has a congenital heart condition and has already undergone an open-heart operation.\u00a0 The heart surgeon has apparently told the family that the second procedure is serious and will be more difficult than the first. \u00a0I told my friend, \u201dThe surgeon was \u2018laying crepe\u2019.\u201d<\/p>\n
The surgeon is an esteemed, pediatric, cardiac surgeon.\u00a0 He knows what he is doing in the operating room, and he knows that the family has a right and a need to be fully informed before consenting for their son to have surgery.\u00a0 This is a serious situation and they deserve to know the good, the limits of good, and the bad.\u00a0 They also need to know if additional surgery will be required in the near or distant future.\u00a0 Thanks to a thoughtful surgeon, they are informed.<\/p>\n
Taking this a step further, I\u2019ve sometimes had patients tell me after the informed consent discussion, \u201cGo ahead and do it, Doc.\u00a0 It can\u2019t be worse than it is now.\u201d\u00a0 My consistent response to that was, \u201cYes, it can always be worse.\u00a0 I\u2019m not sure you were listening.\u201d<\/p>\n
Finally, there is no way anyone can be fully informed.\u00a0 Complications can occur that have never been reported or happen so infrequently that the surgeon feels these unnecessary to discuss for fear of losing the patient\u2019s attention with such a long litany of potential problems that even careful listeners become overwhelmed and stop listening.<\/p>\n
Perhaps the most important part of this discussion is what the surgeon may have left unspoken.\u00a0 No ethical surgeon, except in dire, emergency circumstances when there is no other way to save life or limb, will perform a procedure that he is not confident can be successful.\u00a0 He cannot promise a good outcome or that unexpected complications may not occur.\u00a0 He can only promise that he is confident that he can perform the procedure properly and that he will do his best.<\/p>\n
So, when your surgeon \u201clays crepe\u201d, I think you should consider these things:<\/p>\n