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How much should we inform our patients?

The inclusion of patients in study protocols has long required informed consent, usually in written form. This is an integral part of any scientific protocol. In many countries, informed consent is required if the patient is to undergo normal radiological examinations, especially if contrast media are to be administered. In some countries it is sufficient that the radiologist/radiographer informs the patient orally, but in others information has to be given in written form and the patient has to read and sign a statement that s/he has read and understood the possible complications that could occur during or after the examination. Any injection of a contrast medium carries a potential risk, albeit low, of major or minor complications. Fatal reactions still occur, although extremely seldom, but this information has to be communicated to the patient even if it is just to relate the very low frequency of complications and how seldom serious or fatal complications actually occur -in fact almost never. The big question is how far we should go in informing our patients of the potential risks? Should we tell them that the examination they are to undergo can be potentially fatal, although hardly likely, or should we just inform them very briefly about the common risks and risk factors? In this issue of Acta Radiologica, Aylin Yucel and co-workers report on a multicenter study performed in Turkey. One group of patients was given brief, general, information (Group I) about the common risk factors, while the other group was given more comprehensive information (Group II) (1). Before any information was given, all patients were presented with two different forms to fill in with the purpose of defining anxiety level in that particular situation (Formula I) and how the patient felt independent of that particular situation of undergoing an examination with a contrast medium (Formula II). When the information about the examination was given, brief or comprehensive, the formula on how the patient felt in that particular situation (Formula I) was presented to the patient once more. The interesting, but not unexpected, results from this study showed that brief, general, information reduces the anxiety level, while detailed, comprehensive, information about all aspects of all possible complications clearly increases the anxiety level. Should we stop to inform our patients about the potential risks and complications connected with the examinations they are to undergo? Of course not, but studies like the one Yucel and co-workers present in this issue (1) point to serious ethical dilemmas concerning how we deal with the issue of information to patients. It should not be forgotten in this respect that obtaining informed consent after providing information also protects the radiologist from litigation. Is there a potential future conflict of interests in how we best serve our patients and at the same time protect ourselves from litigation? This article is highly recommended reading.