Junior doctors should not feel pressured to do anything beyond their knowledge, experience and competence, this includes obtaining consent for a procedure that they are not familiar with. Always get a senior to explain or demonstrate it as part of training.
Failure to take consent properly can lead to medicolegal problems including complaints, claims and disciplinary proceedings. If your actions are scrutinised by the GMC you’ll need more than a signature on a consent form to fight your corner. Consent is a process, rather than a form-filling exercise.
"Consent is a process, rather than a form-filling exercise."
Recent GMC guidance emphasises the importance of working in partnership with patients.
- Always act in your patient’s best interests.
- Record in the notes what a patient has been told.
- Use your common sense – consent is patient-specific and depends on the individual’s circumstances, including age, lifestyle, occupation, sporting interests, expectations etc. It may well be that you are not in a position to advise fully eg, professional sportspeople.
- Patients are presumed competent to consent unless proved otherwise.
- Any competent adult in the UK can refuse treatment.
- The law concerning incompetent adults, who are unable to give valid consent, is more complicated, and is different in England, Wales, Scotland and Northern Ireland. If you are in doubt consult senior colleagues.
- Remember there are circumstances where a child can give consent without reference to a parent – if in doubt consult a senior colleague.
Dr U is in his first week as an F2 in ENT. He is sitting at the desk in the ward filling in forms, when a nurse tells him that there is a patient going to theatre, within the next few minutes, who seems to have the consent form missing from his notes.
"Dr U explains that he has never consented a patient before, and doesn’t think he should do it, but, the nurse insists that “it is only a tonsillectomy, not rocket science.”
She insists that the consultant “will get very cross” if the patient turns up in theatre without all the appropriate documentation. The nurse mentions that the patient’s operation has already been cancelled once, and it would be terrible if it happens again. Dr U explains that he has never consented a patient for a tonsillectomy before, and doesn’t think he should do it, but, the nurse insists that “it is only a tonsillectomy, not rocket science”.
Dr U rightly ignores the pressure, and hurries to theatre to ask one of his senior colleagues to sort out the consent form. He agrees, takes the patient’s consent, and the operation goes ahead on time.