Consent success

Top ten tips to assist foundation doctors when consenting a patient for a procedure

1. Never obtain consent for a procedure that you are not familiar with. Foundation doctors should not feel pressured by experienced doctors or other staff to do anything beyond their knowledge, experience and competence.
2. Record in the notes what a patient has been told. The presence of a signed consent form does not in itself prove valid consent to treatment – keep contemporaneous notes which record the key points discussed and relevant warnings given to the patient.
3. Use your common sense – consent is patient-specific and depends on the individual’s circumstances, including age, lifestyle, occupation, expectations etc. If you are uncomfortable consenting a particular patient, always discuss with a senior colleague.
4. Ensure you have documented consent for taking photographs and making recordings. Trusts will usually have specific consent forms that should be used or medical photography departments who can guide you through the process. Do not take photographs on your personal smartphone.
5. Remember there are circumstances where a child can give consent without reference to a parent – if they are Gillick competent they should be considered competent to provide consent. If in doubt consult a senior colleague.
6. Remember, the patient must be competent. The starting point in the case of adults is always to presume that the patient has capacity until it is shown otherwise.
7. The law concerning incompetent adults, who are unable to give valid consent, is more complicated. If you are in doubt consult senior colleagues.
8. Allow the patient to give their consent freely – pressuring patients into consenting to treatment invalidates the consent. Where possible, patients should be given time to consider their options before deciding to proceed with a proposed treatment.
9. Always remember that consent is a process, not a one-off event – it is important to maintain a continuing discussion to reflect the evolving nature of treatment.
10. Ideally consent should be obtained well in advance so that there is time to respond to a patient’s questions and provide adequate information on the procedure is planned. If you are asked to consent a patient immediately before an intervention and are uncomfortable to do so, you must seek advice from more senior members of the medical team.