Each day in my office I go through a ritual with patients called giving informed consent. Basically this means that before I do a procedure (an injection or setting a bone) I try to explain to the patient all of the things that could go wrong with what I’m about to do. In some cases it even means letting a patient know what could happen if they don’t take action to treat a condition.

This is relatively simple in most cases. Almost everyone understands that if I do an injection they could get an infection, or if their arm swells too much in the cast it could cut off their circulation.

Occasionally, though, having a thorough conversation about informed consent is almost impossible. Recently a star quarterback for his high school football team came to me about a concussion. When I pulled him out of the game he could not remember his name or his own number. Over the next few days he had headaches and blurry vision, and couldn’t think straight.

This quarterback (I’ll call him Rob) rested and recovered quickly. By the next week he had no symptoms. His mind had cleared and he felt sharp. By that Thursday he was in my office asking if he could play.

His team was playing its last game. It was full of upperclassmen and Rob was also in his last year. If the team won, it would advance to the playoffs.

Best of all, Rob had been contacted by a scout from a college that was considering offering him a scholarship. The scout was planning to make a visit to watch Rob play.

In my office that afternoon, Rob explained that his season, his high school career, and even his future as a college athlete was riding on that game. He felt great. He wanted to play.

There was one small problem. Rob took a computerized concussion test in my office that day. He scored lower than his baseline, indicating that his brain had not yet recovered. Even though he had no symptoms, the test told me that his memory, reaction time and thinking skills were way off.

I remember paying high prices for auto insurance when I was Rob’s age, even though I didn’t feel I was a bad driver. I recall my surprise when I learned I wasn’t allowed to rent a car until I was over 25. I was frequently scolded when I was younger for diving off bridges and climbing trees that were unsafe.

What I didn’t know then, and what I realize now, was why teens — me, Rob, and all teenagers — are deemed so risky. That day in the office, I explained about the dangers of playing with a concussion, of getting hit again and being paralyzed or even dying. I showed Rob the numbers, clearly outlining that the test revealed that he was not recovered. Rob didn’t hear a word, in part because he couldn’t believe that anything bad was going to happen to him.

Most of us are just like Rob, even as adults. We hear the doctor talking about complications and it washes over us. We think that we’re informed but we’re actually just optimists. When someone tells us that delaying having an operation could lead to arthritis, we don’t actually think it is going to happen.

If we do consider that possibility, it’s very difficult to imagine what that means. What would living with an arthritic knee be like? What do people with brain damage after concussions actually go through each day? We don’t have any way of knowing, so we nod and mentally move on.

So the next time you hear a doctor going through an informed consent process, try a different approach. Ask questions: “Is this a likely complication? What do you mean by ‘nerve damage?’ What would you do if you were me?”

Most of all, help your children with issues of informed consent. Don’t send a teenager into the doctor’s office alone. Give them the benefit of your experience and your perspective. Every day I rely on my athletes’ parents as they lend their voices to my conversations with their teenagers.

In the end, Rob’s father came to see me with his son. The three of us had a great discussion. He helped Rob see that his football career (and his life) was about more than one game. Rob sat out that Friday and watched his team make the playoffs. The college scout was there to see him the next week when a clear-headed Rob led his team to its first-ever playoff victory.

 

Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the Portland Pirates and the U.S. ski team.