Perils of miscommunication: The beginnings of informed consent

Abstract

This article addresses the perils of miscommunication and the beginnings of informed consent in a landmark United States common law, Schloendorff vs Society of New York Hospital. For a century, Schloendorff has been understood as a case of surgery performed without consent on an anesthetized patient after a pelvic mass was discovered. This case illustrates the clinical ethical errors that occur when physicians fail to communicate with each other and with their patient. To support this interpretation, we review the original medical and surgical records, letters of key participants in the case, and the trial court record. Ms Schloendorff actually lost her legal case. Indeed, her surgery might not have been performed at all had her clinicians known, communicated, documented, and reaffirmed what the patient actually wanted. This new interpretation of Schloendorff is important for contemporary obstetric and gynecologic care, because it documents the perils of the medical errors of implicit consent, delegating the obtaining of consent, and miscommunication among clinicians. From the perspective of the lessons taught by Schloendorff, the modern culture of patient safety and quality that has come to define excellent obstetric and gynecologic care, including ultrasound, should be understood as a powerful preventive measure against the clinical ethical perils of miscommunication that reduce the quality of patient care and unnecessarily compromise professional obstetric and gynecologic ultrasound.