A Survey of Psychiatry Residents' Informed Consent Practices

Objective: A survey was used to investigate whether psychiatry residents obtained informed consent for treatment from 3 hypothetical patients.

Method: Clinical vignettes describing 3 patients with (1) major depressive disorder being prescribed medication, (2) borderline personality disorder starting psychotherapy, and (3) neurotic character traits starting psychotherapy were distributed to psychiatry residents at 7 New York City-area training programs. Necessary components of an informed consent discussion were defined a priori by means of a literature review and consultation with experts in informed consent. Residents’ responses to questions about the vignettes were then examined to determine whether the residents would engage in an informed consent discussion with the hypothetical patients. The study was conducted from January to March 2005.

Results: 108 (49%) of 220 subjects reporting on a total of 324 vignettes returned the questionnaire. Responses to 8/324 vignettes met the minimal criteria established for an informed consent discussion. More residents reported they would initiate discussions with the depressed patient compared to the borderline and neurotic patients about diagnosis and prognosis, information about the recommended treatment, and side effects. A measure of what residents revealed about themselves to patients was also greater for the depressed patient compared to the borderline and neurotic patients. When the informed consent criteria were made less restrictive (requiring only that residents provide information in response to patients’ questions rather than initiate the discussion), 173/324 vignette responses met the criteria.

Conclusion: Psychiatry residents did not initiate informed consent discussions with the hypothetical patients in this study, but they reported that they would provide appropriate information when asked by the patients. These results suggest that changing residents’ passive approach to informed consent discussions might have a large impact.