Twerski & Cohen's Second Revolution: A Systems/Strategic Perspective

In an article published in 1992, Professors Twerski and Cohen suggested that basic principles of the law of informed consent require medical providers to tell their patients about competing providers could perform the same procedures better or more safely. In its 1996 decision in Johnson v. Kokemoor, the Supreme Court of Wisconsin cited Twerski and Cohen's article in holding a neurosurgeon liable for not telling a patient of such a competitor. As a result, Twerski and Cohen now argue, the law of informed consent now stands on the brink of a second revolution. This comment sets forth a systems/strategic analysis of Twerski and Cohen's proposal. That is, using the delivery system for coronary bypass graft surgery as an example, it describes the current system's operation, projects how the system would operate with Twerski and Cohen's proposal in place (by exploring the strategies that patients and providers would be likely to pursue), and then evaluates the two comparatively. The comment concludes that even if the proposal were adopted immediately, the resulting change would proceed at a moderate pace. Over the long run, the proposal would tend to align the interests of providers with those of their patients and work a substantial net improvement in system operation.