The study carried out at Cork University Hospital (CUH) found that changes are required in the consent process and recommends the use of multimedia adjuncts to facilitate both patient and doctor.
The study also highlights the difficulties encountered by consenting doctors, an issue which may lead to patient dissatisfaction, threaten the efficient running of a surgical unit and potentially expose its staff to avoidable litigation.
The authors surmise that an effective strategy needs to be developed to improve on current deficiencies.
The authors suggest this is best served through a combination of pro forma (provided in advance and showing description) consents for common procedures and, with the help of multimedia tools, the education of both doctors and patients. There is a deficiency in the clinical guidelines on consent taking, according to the report.
The Irish Medical Council’s recommendations on documentation are brief, but advocate that all details of the discussion be recorded in the medical notes of the patient. Britain’s General Medical Council recommends that the medical records or consent form are used to record the “key elements” discussed.
These should include the information discussed, specific patient requests, particulars on audio or visual aids employed and details of decisions made.
Neither the Irish nor British councils have clear guidance on the disclosure of risks. The consenting process for an elective procedure at CUH involves a discussion at the outpatient visit prior to the procedure. The final discussion and filling of the consent form does not happen until admission.
For this study, a review of theatre consent forms was performed along with an anonymous survey of non-consultant hospital doctors (NCHDs).
Of the consents gathered, only 5% contained a record of the specific risks involved. In 9% the consent had to be subsequently altered. In 29% of cases NCHDs said they were unsure of the procedure or the risks. There were no postponed procedures due to documentation failings.
Several authors have suggested mechanisms through which this study’s issues might be addressed. These involve using pre-written, procedure specific forms, which outline the risks and possible complications of the common procedures.
A system such as this has limitations, particularly in the area of emergency surgery, where the procedure has to be individualised. In the elective setting, it would provide a standardised template for both patients and doctors.