At our recent seminar “A Practical Approach to Consent”, 29 Feb – 02 Mar, 2016, we asked members to submit questions to our panel of experts. Here, medicolegal adviser Dr Zaid Al-Najjar answers some of the questions raised.
Q: How do we check our patients have really understood what we have told them? How do we ensure they don’t forget?
A: Checking patient understanding is a clinical skill and has been written about at length in medical literature. One method would be to ask a patient to reflect back to you what they have understood about the information you have just put to them. Medical Protection offers several courses (for example shared decision making) which our members might find useful if this is an area of particular difficulty.
Q: Is it ok to take blanket consent for a course of treatment or do we need to do consent for each treatment?
A: Each procedure/treatment would require a practitioner to go through the consent process, so that the patient understands the treatment options, the risks and benefits of each so that they are able to make an informed decision. A tailored approach is far preferable to a blanket one.
Q: When patients ask me "help me make the decision," what should I say?
A: It can be tempting to take a paternalistic approach, but modern medicine, and patient expectations increasingly focuses on a patient centred approach and shared decision making. In circumstances where a patient wants a practitioner’s opinion on the best option, it would still be incumbent on the practitioner to go through the consent process, i.e. the different options, and risks and benefits of each, and then provide their opinion (which they should be able to justify) as to what they feel the most suitable one was for the patient.
Q: Is a procedure form/risk acknowledgement and consent form sufficient?
A: Completed consent forms provide some evidence that consent was obtained, but mean little beyond that – it is important to realise that they do not constitute proof that the consent was valid. If there is any dispute over whether valid consent was obtained, the key issue will not be whether the patient signed a form or not, but whether they were given all the information they needed to make a considered decision. It is, therefore, crucial that the essential elements of discussions with the patient are documented in the medical record.
The notes do not need to be exhaustive, but should state the nature of the proposed procedure or treatment and itemise the risks, benefits and alternatives brought to the attention of the patient. Any particular fears or concerns raised by the patient should also be noted.
Q: Who should do the consent form - the person doing the procedure or the doctor who leads the team?
A: This is preferable but not always possible however the person taking consent (and I stress taking consent rather than ‘doing the consent form’ is appropriately trained/qualified, has sufficient knowledge of the proposed procedure/treatment and understands the risks involved, so that he/she can have a proper conversation with the patient and answer any questions which may be posed as a result.