Re: Informed consent

["Gibbs, S Julian" <s.julian.gibbs@vanderbilt.edu>]

I must confess confusion re the multiple concerns expressed 
as to why patients may not be adequately informed about 
radiation risks from diagnostic procedures involving x rays 
or radioisotopes.  Especially when this comes from a group 
who have just harangued re absence of proven risk from 
small radiation doses (the LNT controversy).  It seems 
that many of us are "talking from both sides of our 
mouths."

I think that most readers of this list will agree 
that risk to patients from typical diagnostic 
radiologic procedures are vanishingly small.  The most 
common diagnostic x-ray procedures are chest and dental; 
effective doses from these are of the order of 1 mrad.  
Other procedures  (these are CT, barium enema, etc.), done 
much less commonly and only after consideration of benefit, 
may give effective doses up to 1 rad--rarely more.

Current regs and procedures require that patients be 
informed of risks that have a reasonable chance of 
occurring--but not all infinitesimally small risks.  It is 
simply not possible to discuss everything with every 
patient.  Thus patients are informed of risks of contrast 
media (for example) but may not be fully informed of 
radiation risks for low-dose procedures. However, 
discussion with the patient ends with "Do you have any more 
questions?"  Patients should ask.

I too am chagrined at the absence of radiation science in 
the medical school curriculum.  In years past I had two 
hours of lecture time here at Vanderbilt to discuss such.  
Now I am crowded out.  The grounds are that there are many 
other topics of equal or greater importance that are not 
covered. There is simply too much material to cover in four 
years.  It is assumed that most of what graduates need to 
know will be addressed during residency.  That is generally 
true.  However, radiation science enters only into 
radiology residency training.  All other specialties get 
none.  Surgeons, for example, get what they need to know 
about surgery.  Only surgeons perform surgery.  However, 
only radiologists get what they need to know about 
radiation science.  Everybody wants part of the radiology 
action.  It is alarming that the percentage of radiologic 
procedures performed by radiologists is decreasing.  A 
growing fraction is being done by physicians with 
inadequate background in radiology.  Even worse, equipment 
operators may have learned all they know from equipment 
salesmen.  Managed care seems to want everything performed 
by the least qualified personnel they can get away with.  I 
didn't intend to get into that sermon, but I won't charge 
for it.

Hope this helps.  At least it is off my chest.
***********************************************************
S. Julian Gibbs, DDS, PhD               Voice: 615-322-3190
Professor of Radiology                    FAX: 615-322-3764 
Dept. of Radiology & Radiological Sciences
Vanderbilt University Medical Center
Nashville TN 37232-2670 Email:s.julian.gibbs@vanderbilt.edu
***********************************************************
If it's free, it's advice;
If you pay for it, it's counseling;
If you can use either one, it's a miracle!

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