Informed consent to satisfy everyone

Abstract

A surgeon when obtaining consent from a patient for surgery would certainly like to have the patient fully comprehend all aspects of the intended surgery, the beneWts, the consequences of not having surgery, the risks and complications of the procedure and the likelihood of such occurring. The surgeon would also like the other stakeholders of this process, the caregiver, the nurses, the governing medical council, the medical protection society and even the judiciary to be fully satisWed with the process of informed consent. Such an ideal situation, however, remains elusive. A busy clinic or surgical practice, the literacy level of the patient and the lack of easily understandable medical material for patient information often serve to prevent eVective and eYcient communication between the surgeon and the patient. It is widely accepted now that greater patient understanding through more eVective communication and information provision reduces patient anxiety [1, 2]. In cases where litigation arises, good documentation with regards to information provision is often woefully inadequate in the judgment by surgical peers and of the judiciary. A structured standardized consent form with a checklist documenting risks and outcomes is a good step forward. The National Health Service (UK) consent form of April 2002 is a good start [3]. Although still imperfect, as is suggested by the following study, it nevertheless is a good move in the right direction. The study by Goodyear et al. published in this issue showed that 33% of otolaryngology patients with postoperative complications did not have such complications recorded in their consent forms prior to surgery, and 74% of postoperative complications judged as frequent and serious, which actually occurred, were not recorded in the consent form prior to surgery thus suggesting a failure to document and discuss risks and complications eVectively with patients during consent taking. It has been suggested that, given the variable literacy level of patients, images and diagrams that are specialty and procedure-speciWc be included in a consent checklist [4]. Given the vast number of surgical procedures existent today, such a checklist may prove to be too varied and voluminous in paper form. Information technology may provide a solution by allowing such images and diagrams to be recalled in a clinic or ward setting on a monitor for the patient’s inspection and his acknowledgement on a signed consent form. Such a project could be undertaken nationwide with a panel of stakeholders, the surgeons, patients, caregivers and legal representatives directing software engineers in its design. Informed consent being a universal process may result in such software being sought after by the international surgical community thus making such software development commercially viable. Constantly reviewing the imperfections of the process, redesigning and harnessing information technology to provide a better tool for communication may hopefully lead us to an informed consent that will satisfy everyone.