While the recent Pennsylvania decision on surgical consent centers on a physician's responsibility, it did not consider how it emotionally binds the physician to the patient. The ritual of consent has many layers to consider. 
When I was 17 years old I had every place kicker s nightmare: ingrown toenails. Worse was that I ignored the problem for too long and had to have them professionally removed. My pediatrician referred me to a local podiatrist and I left school early one day to get my toes clipped.