Transparency in Medicine: How much should patients know

In today’s clinical practice it is very important to communicate with the patient and their family. This communication ranges from the details of disease processes and investigations to treatment options and prognosis. Not only said information, but also their agreement to opt among these options. This communication should be clear, honest and according to the understandings of the patient and family. This is known as Patient Centered Approach. This forms the basis of the relationship between the patient and physician. However, this transparency must be balanced with professional discretion, especially when it comes to technical decisions in complex procedures.

Here is a real-world case that I came across recently:

A patient had severe triple-vessel coronary artery disease. As he was above 70 years of age with some psychiatry issues, his family refused coronary artery bypass grafting (CABG) and opted for a high risk angioplasty. The attending consultant planned the procedure with mechanical circulatory support device and conveyed this plan to the patient’s family. Unfortunately, the consultant forgot to confirm the availability of the required device and the procedure had to be canceled at the last moment. When informed, the patient’s relatives became agitated, leading to a tense situation that required intervention by hospital administration. Eventually the family was informed that performing angioplasty without device carries high risk so they agreed for conservative medical therapy and patient was discharged home.

These kind of incidents are not uncommon in hospitals.

This incident raises an important question:

To what extent should patients and their families be informed about procedural plans, especially regarding specific equipment or techniques?

Patients have a fundamental right to know:

The nature of the procedure
Its risks and potential complications
Alternative options
What outcomes they can expect, good or bad

This is called an informed consent, which is both an ethical and legal obligation. In high risk procedures, the consent form should clearly state that there is higher risk complications including death even with best efforts.

However the consent discussion should not include technical details. Most patients and their families are unable to understand or make decisions about which device is best suited for a specific procedure.

That decision should be made by clinical team based on availability, and what is required at the time of procedure.

The Professional Domain: Technical Decisions

Choosing specific equipment, catheters, guidewires, stents, or circulatory support devices is a clinical decision based on:

The experience of the doctor
Hospital policies and protocols
Patient’s condition during the procedure
Availability of the equipment

If the doctor gives too much detail to the patient or relatives this can lead to

High but unrealistic expectations
Confusion or anxiety in families
Loss of trust if plans change suddenly

So while it’s important to be honest, doctors should also use their professional judgement and should explain the things in a clear and general manner such as:

“This is a high risk procedure. We will use all available resources including certain support devices if required and will try to keep the procedure as safe as possible. What we will do will depend on what are our findings and how the patient responds.”

Communication: Setting the Right Expectations

In emotional and tense situations like this it’s very important to prepare the family properly keeping in mind the above mentioned points. The family must understand that:

Plans may need to change during the procedure depending on patient’s condition
Some equipment or devices may not be available so alternate resources may be used
The medical team is well trained to assess and adjust and make the best decisions according to situation

In the case above, had the family been told in this manner they might not have reacted so aggressively when the plan changed.

Conclusion: Informed, but Not Burdened

Patients and their families have every right to know the goals, risks, and overall plan of any procedure. But they should not worry about technical details. That is the doctor’s job. Over-promising and creating high expectations can cause trouble if circumstances change.

Ultimately, the goal is to keep communication honest, clear, and caring providing enough information for informed consent, without overwhelming the patient or binding the medical team to fixed technical choices.

Transparency in Medicine: How much should patients know