Earlier this summer, the Supreme Court of Pennsylvania ruled that a physician cannot delegate obtaining informed consent from a patient to a member of her staff. In Shinal v. Toms, a neurosurgeon perforated a patient’s cranial artery while resecting a tumor, which led to hemorrhaging, brain damage, and partial blindness. The patient alleged that had she known the full risk of the surgery, she would have opted for a less dangerous course of treatment. While the risks were communicated to the patient, they were communicated by the physician’s assistant, not the neurosurgeon himself. After the lower courts both ruled for the physician, the Supreme Court of Pennsylvania reversed, holding that the courts below erred in allowing the jury to consider statements made by the physician’s assistant to the patient — because responsibility to obtain informed consent is the physician’s alone and cannot be delegated. According to the court, “[i]nformed consent requires direct communication between physician and patient, and contemplates a back-and-forth, face-to-face exchange.”
While requiring physicians to give risk information in person sounds appealing, it runs counter to efforts to utilize physician time more efficiently. Physician time is expensive — and rightly so. After college, medical school, internship, residency, and any number of fellowships, physicians have undergone a staggering amount of training. In light of this investment in human capital, it’s no surprise that the hourly rate for anything a physician does is astronomical. This makes sense when those hours are spent performing neurosurgery, reading radiographs, or engaging in other activities that require the full extent of a physician’s medical training. But it can lead to sizable inefficiencies when those hours are spent on tasks which can be readily done by qualified staff members, such as nurse practitioners, registered nurses, and medical assistants, at a fraction of the hourly rate.