Variations in the quality of consent for open mesh repair of inguinal hernia

Abstract

Correctly performed informed consent acts as a shield against complaints by patients and claims of malpractice against doctors. Inguinal hernia repair accounts for 10% of the general surgical workload and shows a marked variation in the consenting of individuals. To compare the variations in consenting practice among various grades of surgeons for the primary repair of open inguinal hernia with specific reference to the documentation of significant risk of surgery. A proforma was devised which included the grade of the surgeon and significant and/or commonly recognised complications of the open repair of inguinal hernia. This was then cross-referenced with the consent forms for the 47 patients and the documented risks explained in each case were noted. A considerable variation was noted in the documentation of complications by various grades of surgeons. Of the 47 consent forms assessed, only five were completed by the consultant who was performing the operation, 26 were completed by Specialist Registrars (SpRs), 14 by Senior House Officers (SHOs), one by a staff grade and one by an intern. Consultants are less likely to mention recurrence (60%) than juniors (SpR 88% and SHO 93%). They are, however, more likely to mention the complication of chronic pain (60% vs. 35% for SpRs and 7% for SHOs). Patients are not provided with consistent information to make informed consent. There is a need for standardised consent forms to achieve consistency and effectiveness of the consenting practice of inguinal hernia surgery.