Radiologist Earl R. Miller, M.D.

Consent forms for radiologic procedures did not even exist when I entered my residency or when I came to UCSF in 1940. Patients were referred to Dr. Newell and to Dr. Stone for Radiation therapy and the doctors administered it. People trusted their doctors then and they were not litigation happy. There were fewer lawyers and all the world was a great place.

Even today, I think it is not customary for a patient to sign a consent form for receiving digitalis or other potentially lethal drugs. It is interesting that Radiology as a profession was singled out early to need consent for accepting treatment with the usual modalities and for the radioisotopes.

There was a lot of vigorous discussion about the need for consent forms to be signed by people receiving the new- found radioisotopes during WW II. I think it was the AEC that stirred up the monkeys. I think it was Dr. Shields Warren who opposed the idea vigorously. I agree with him provided that the material was to be administered by someone especially trained to understand and to use properly the material in question.

Let us look at the problem of "Informed Consent". A patient, a layman, enters a Radiologist's office for diagnosis and or treatment with one of the usual modalities or with some radioisotope. Now the doctor explains as well as he can the good and possible side effects that the procedure entails. In order for that person to give a TRULY INFORMED CONSENT, the patient needs only to go to College, to Medical School and to serve an internship and a Residency in Radiology to sign that INFORMED CONSENT. If you do not believe that, try having a patient explain to you his understanding of all the nuances that were involved in his signing that consent form.

Then ask him some questions about something just a little peripheral to the main question, but is still important in the total understanding of the problem, and if you still believe that there is informed consent you are welcome to your beliefs. Consider the problems of a patient signing a consent form for major surgery.

After the War, Dr. Stone returned and took over the chairmanship of the Radiology Department at UCSF. What a load off my shoulders! I had learned that I would never again be chairman of a Radiology Department. At some time about then, Ken Scott came to UC, I think, to work with Dr. Stone in his new Radiologic laboratory. I believe that by this time Joe Hamilton had died and the Donner Lab sort of folded up. That left Ken Scott with no job.

Ken Scott's name comes into this because he was involved as chairman of a committee at UCSF, which committee was concerned with consent forms from patients and from doctors who planned to do studies with radioisotopes.

Up to this time, radioisotopes were used for diagnosis and treatment of patients by radiologists who knew what they were doing and had spent a great deal of time knowing about the safety and the dangers of the materials and of the radiation involved. After the War, a number of doctors, not radiologists, got interested in the use of radioisotopes for their research and, in some cases for the treatment of their patients. Most of these had a 6 months course in diagnostic Radiology during their days in Medical School. This hardly trained them for the use of the new materials. As a result, Scott's committee was set up to examine the protocols of intended research and to determine if the person responsible had sufficient training and knowledge to carry out the work safely. If the committee was satisfied, their gave their blessing and the papers were sent to President Sproul's office for permission to proceed.

I hope this is a proper time to air one of my beefs about the scare-mongers and the misguided "in-depth" reporters who present in the media a distorted view of the dangers of radiation and cause needless anguish to those who must be exposed to it. The most common distortion involves the failure to differentiate between radiation properly given to a confined area for a purpose important to the patient's health and total body radiation from cosmic rays or from some industrial source. A layman can hardly be expected to detect the slant and they become afraid. What a bummer!!

A classical example of slanted reporting came from the woman in Albuquerque who published a three part series of many pages in the Albuquerque Paper a few years ago. I have happily forgotten her name. If I remember correctly she was given a big prize (Pulitzer?) for the work. These articles were slanted through errors of omission and of commission to present a frightening view of the dangers of radiation. To present an example of the damage that this kind of reporting does let me tell you the story of a grandmother who was coughing her head off and needed a radiologic chest examination. She refused to have the procedure done because the danger to her grandchildren. This is true story that happened to me. Even intelligent people have that kind of fear. It is the fear of the unknown and it is fired up by some, both in and out of the Medical profession, who get on the scare band wagon for the fame that it brings them. Things that scare people always sell.