Should You Seek 'Operative Request' Rather Than 'Informed Consent'?

Emerson Crawford Jr., DDS


January 26, 2023

Many of us who entered private practice three to five decades ago (or even recently) had little to no knowledge of business or practice management, as most of our faculty, attendings, and professional mentors were academicians, not private practitioners. As a result, learning the subtleties of business, office design, practice flow, and professional responsibilities regarding patient management and communication was often challenging.

Most professionals in surgical fields can, to some degree, help patients understand what to expect from surgical procedures — specifically, desired and probable results as well as potential risks and adverse outcomes, both temporary and permanent.

Options and alternatives, as well as the risks of doing nothing, should always be considered and discussed. Traditionally, this educational process was referred to as a "presurgical consultation."

During that consultation, after discussion of the procedure and its objectives, and after questions are answered, the patient is given an "operative request" — a paper or digital document referencing the procedure's risks, potential outcomes, and alternatives. By signing the document on the day of the presurgical consultation (in the presence of a third-party witness), the patient thereby "requests" that the surgery be scheduled and performed.

On the day of surgery, after the patient has had time to think things over, maybe having done some research or gotten a second opinion, the patient is invited to ask further questions. Patients who are satisfied with the treatment plan sign and date the "operative request" a second time, just prior to the procedure.

Over the years, a slightly different approach and use of terms have developed among healthcare professionals. Once all the aspects and potentials of the procedure or therapeutic process have been reviewed, the patient is said to have participated in an "informed consent" discussion.

The concept of "informed consent" has been with us since the late 1950s. The general definition of the term is "a process of communication between a patient and a healthcare provider that often leads to agreement or permission for care, treatment, or services."

To formalize that discussion, the patient signs an "informed consent" document. Indeed, both the presurgical or pretherapeutic consultation and the signed document have been lumped together, and the combination is called "informed consent."

The term "informed consent" perhaps originated during the early days of research in new medical therapeutics and the development of advanced surgical equipment and techniques. Patients had to be informed about these recent technological and surgical developments, and then consent to the treatment or procedure — knowing that experience with these techniques and their outcomes was minimal.

If the healthcare provider or surgeon was still a student or resident, "consent" was definitely a good choice of terms. Perhaps surgeons or other health professionals who left these research-heavy institutions carried that terminology with them into practice and helped boost its popularity.

My training was at UNC Chapel Hill, where the "presurgical consultation" followed by the "operative request" document was used both in the outpatient clinic and for the operating rooms at North Carolina Memorial Hospital. Since entering private practice, both in my office and my hospital (Pitt County Memorial Hospital), we utilize the operative request protocol.

Now that the hospital has grown to become Vidant Medical Center with over 1000 doctors on staff, a medical school (ECU Brody School of Medicine), and a large surgicenter, it has modified the document slightly to "request for operation." It is my guess that "operative request" or "request for operation" is (correctly) utilized around the United States more than one might imagine.

For those of you who have not used that term, I encourage you to consider it, as I think it appropriately reflects a more positive tone in your relationship with your patient.


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