Informed Consent

Ideally, informed consent occurs when a physician recommends a procedure or a medication to a patient. The physician should be explaining why the procedure or medication is necessary. How it will benefit the patient. What risks exist with said procedure or medication. What risks exist if said procedure or medication is declined by the patient. The patient should also know what other treatment alternatives exist other than the medication or procedure being discussed.

Is informed consent occurring? I know that when I prescribe a new medication to a patient, I usually explain the major potential side effects to the patient. But I don’t explain the minor ones. One could suggest that I am not providing an opportunity for truly informed consent. I would suggest that when a drug monograph listing potential side effects is pages long, then yes, I may not gain truly informed consent, but that that is a lofty goal that I may never meet. 

Thankfully, it is much easier for me to obtain informed consent when I practice Lifestyle Medicine; in particular, when I prescribe and recommend dietary changes to patients. Why is LM necessary? To treat and in some cases reverse the chronic disease that the patient has spent a lifetime (sometimes longer, sometimes shorter) accumulating, thanks to the Standard American Diet (aptly “SAD”). How will LM benefit the patient? Well, it will treat if not reverse the chronic disease(s) they have, including decreasing, sometimes even eliminating any chronic pain they have. Not only that, LM changes will drop their risk of heart disease, diabetes (II), Alzheimer’s, and certain cancers. What risks exist with LM? The biggest risks with LM, in particular with adopting a Whole Foods, Plant-Based (WFPB) way of eating, are: an increase in flatulence during the first week of any dietary change may occur; and, if there is excess weight the person may experience weight loss. 

What risks exist if LM is declined by the patient? Well, the patient’s chronic disease will continue to progress. They will drop their risk more if they take medications, but even by taking medications that may make their “numbers” look better (hypertension, cholesterol, diabetes), the underlying pathology that is manifesting as hypertension, hypercholesteremia, or diabetes II continues unabated. So yes, there is an alternative to LM changes, but the alternative, taking medications, will not arrest the underlying disease, which of course is why the patient will need to continue to take the medication for the rest of their life. The chronic disease is not being “treated,” but is being “managed,” and one may argue that it is not managed well if the underlying disease progresses in spite of medication.

The good news for me, is that my conversations surrounding informed consent are relatively short when I am discussing LM changes with my patients. What is a bit more awkward, is the question: do patients get that conversation with informed consent when they see a clinician? It is possible that they are not having that conversation, in part because clinicians sometimes do not realize that anti-hypertensives and statins, for example, drop a person’s risk, but not as much as appropriate changes in lifestyle. Clinicians, including other health professionals, are not providing informed consent when they recommend to patients that olive oil (yes, even EVOO), coconut oil, chicken, and fish, are healthy. They are not.

I would argue an important part of the conversation, in discussing possible treatments, should be that if the patient were to instead change their diet and lifestyle, then the medication would not be necessary, AND the patient will lower their risk much further than they can by taking a pill. As I write this, however, I realize that I will not always mention that to a patient when I see them in a walk-in clinic and they ask for a refill of their medication. Note to self: informed consent is something I should be striving for, and therefore I should be providing that information as much as possible.

Dr. Jennifer Purdy