“I probably should do that”

Now, back to why I chose the title for this essay ("I probably should do that"). I was at a diabetes meeting this past weekend, and was chatting with another physician-attendee about using a diabetes drug in an off-label setting. I pointed out that he might want to get the patient to sign an informed consent; his response was "I probably should do that."

When I was in office practice, I routinely had patients sign off on their care plans (as well as me signing off on the plans), and if a drug was to be used off-label, that was part of the care plan. So it doesn't need to be an official looking document labeled with a pretentious title like "Off-Label Use Informed Consent Plan Form." But it should be very clearly documented that the patient was aware of the off-label use, and that the patient understood the risks as well as the benefits, and agreed to the off-label use.

That's the ethical thing to do.