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Meaningful Informed Consent. The 4 crucial pillars it is formed on. All 4 must exist.

More dialogue on informed consent in response to an inquiry: 4 pillars are essential.

A few things. MDs in Radiology are called Radiologists. The technologists who take the studies are Radiology technologists and you could call them radiographers as well.

I think you are based in the UK. A country sorely lacking in physicians prepared to stick their neck out and say individuals with normal kidney function can get sick from GBCA injection.

But in this case, you are right this is a 4D chess game... and as I write this I have to think of the comparison with Pablo Picasso. For someone to truly know an informed risk/benefit analysis, one has to have the following: i) a very good grasp of the diseases involved. ia) their potential severity and ib) their likelihood. ii) A very good knowledge of the procedure/ intervention and its benefits. iii) one has to have a very good grasp, and really best if it is direct experiential knowledge, about the risks of the intended procedure or intervention. iv) knowledge of alternatives, and their risks/benefits. The alternative I am most fond of is; doing nothing. You know these 4 issues well, then you can provide a meaningful informed consent.

I think a good analogy is Pablo Picasso and modern art: Picasso was extremely capable of painting highly realistic paintings, even at the age of 15. He ended up following various paths of progressive abstraction.... but it was on the foundation that he really knew how to paint an image of a house that really looked like a house and a person that really looked like that person. Subsequent to Picasso, and Juan Miro, most modern abstraction type artists have missed the first crucial step of being an artist: these originals really could paint entities extremely well. Most modern artists have skipped point 1 and jumped into point 2: their 'inspiration'. Without point 1, their inspiration is no more important than that of any 6 yr old child painting a picture of a house, their family, and the dog, and a tree and the sun in the background. Or what I could do as a painter.

So you really cannot provide fully knowledgeable informed consent if you do not know the four points (pillars) above. The other analogy I use to illustrate lack of knowledge somehow been misconstrued as expertize is the fairy tale of the emperor's new clothes.

If you don't know GDD, then you really are not able to provide meaningful risk/benefit analysis for MRI. If you don't know medical radiation risks, including how it varies with age, then you really are not able to provide meaningful risk/benefit analysis for CT. If you don't know the radiation exposure that result from the use of the radiotracers you are using then you are not able to give meaningful risk/ benefit for nuclear medicine/ PET.

Richard Semelka, MD


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