DISCLOSURE PRIOR TO CONSENT

DISCLOSURE PRIOR TO CONSENT

In surgical practice, respect for autonomy translates into the clinical duty to obtain informed consent before the commence ment of treatment. It is easy to underestimate the gap in understanding between 2 a surgeon and his or her patient. How many patients would recognise that unilateral eye surgery might lead to contralat eral blindness? The risks and side e ff ects of many operations are not intuitive, and the surgeon is not in a position to guess how the patient’s plans for employment, leisure and family life may be inadvertently a ff ected by a foreseeable complication. A b udding Olympic gymnast might choose to forego surgery on a quiescent posterior triangle lesion if he or she knew the poten tial consequences of division of the accessory nerve. That is why patients need to be informed, beforehand, so they can choose whether or not to take the risk. To establish valid consent to treatment, patients need to be given appr opriate and accurate information. In England and Wales, the Department of Health’s (DH) Reference Guide to Consent for Examination or Treatment (second edition) should be consulted, together with the General Medical Council’s (GMC) most recent guidance Decision Making and Consent (GMC 2020). Such information, disclosed during a formal and tangible discussion, must include: /uni25CF the condition and the reasons why it warrants surgery; /uni25CF the type of surgery proposed and how it might correct the condition; /uni25CF the anticipated prognosis and expected side e ff ects of the proposed surgery; /uni25CF the unexpected hazards of the proposed surgery; /uni25CF any alternative and potentially successful treatments other than the proposed surgery; /uni25CF the consequences of no treatment at all. With such information, patients can link their clinical pros pects to the management of other aspects of their lives and the lives of others for whom they may be responsible. Good professional practice dictates that obtaining informed consent should occur in circumstances that ar e designed to maximise the chances of patients understanding what is said about their condition and the proposed treatment, as well as giving them an opportunity to ask questions and express anxieties. Where possible: /uni25CF a quiet venue for discussion should be found; /uni25CF written material in the patient’s preferred language should be provided to supplement verbal communication, together with diagrams where appropriate; /uni25CF patients should be given time and help to come to their own decision; /uni25CF the person obtaining the consent should ideally be the sur geon who will carry out the treatment. It should not be – as is sometimes the case – a junior member of sta ff who has never conducted such a procedure and thus may not have enough understanding to counsel the patient properly . obtaining informed consent for surgery . It is not good enough just to go through the motions of providing patients with the infor mation required for considered choice. Attention must be paid to: /uni25CF whether or not the patient has understood what has been - stated; /uni25CF avoiding overly technical language in descriptions and ex - planations; /uni25CF the provision of translators for patients whose first lan - - guage is not English; /uni25CF asking patients if they have further questions. When there is any doubt about their understanding, patients should be asked questions by their surgeon about what has supposedly been communicated to see if they can explain the information in question for themselves. - Surgeons ha ve a legal as well as a moral obligation to obtain consent for treatment based on appropriate disclosure. Failure to do so could result in one of two civil proceedings, assum - ing the absence of criminal intent. First, in law , intentionally to touch another person without their consent is a battery , remembering that we are usually touched by strangers as a consequence of accidental contact. Surgeons have an obli - gation to give the conscious and capacitous patient su ffi cient information ‘in broad terms’ about the surgical treatment being proposed and why . If the patient ag rees to proceed, no other treatment should ordinarily be administered without fur - ther explicit consent. The second legal action that might be brought against a surgeon for not obtaining appropriate consent to treatment is in the tort (civil wrong) of negligence. Patients may hav e been given enough information about what is surgically proposed to agree to be touched in the ways suggested. However, sur - geons may still be in breach of their professional duty if they do not provide su ffi cient information about the risks that patients will encounter through such treatment. Although standards of ho w much information should be provided about risks vary between nations, as a matter of good practice surgeons should - inform patients of the hazards that any reasonable person in the position of the patient would wish to know . In UK law , this level and style of disclosure has been most recently reviewed in 2 the case of Montgomery v Lanarkshire Health Board. Finally , surgeons now understand that, when they obtain consent to proceed with treatment, patients are expected to sign a consent form of some kind. The detail of such forms can di ff er, but they often contain very little of the information supposedly communicated to the patient who signed it. Partly for this reason, the process of formally obtaining consent can become overly focused on obtaining the signature of patients rather than ensuring that appropriate disclosure has been pro - vided and understood. It is important for surgeons to understand that a signed consent form is not proof that valid consent has been properly - obtained. It is simply a piece of evidence that disclosure may have been attempted. Even w hen they have provided their sig - nature, patients can and do deny that appropriate information has been communicated or that the communication was e ff ec - tive. Surgeons are therefore well advised to make brief notes ments, especially information about significant risks. These notes should be placed in the patient’s clinical record, perhaps by referring to the disclosure in the letter to the family doctor, copied to the patient. In addition, inf ormation sheets describ ing the generic risks, benefits, complications and alternatives associated with the proposed procedure can be provided. It seems that, soon, a record of dialogue will replace the consent form; see GMC (2020), para. 55. DISCLOSURE PRIOR TO CONSENT

In surgical practice, respect for autonomy translates into the clinical duty to obtain informed consent before the commence ment of treatment. It is easy to underestimate the gap in understanding between 2 a surgeon and his or her patient. How many patients would recognise that unilateral eye surgery might lead to contralat eral blindness? The risks and side e ff ects of many operations are not intuitive, and the surgeon is not in a position to guess how the patient’s plans for employment, leisure and family life may be inadvertently a ff ected by a foreseeable complication. A b udding Olympic gymnast might choose to forego surgery on a quiescent posterior triangle lesion if he or she knew the poten tial consequences of division of the accessory nerve. That is why patients need to be informed, beforehand, so they can choose whether or not to take the risk. To establish valid consent to treatment, patients need to be given appr opriate and accurate information. In England and Wales, the Department of Health’s (DH) Reference Guide to Consent for Examination or Treatment (second edition) should be consulted, together with the General Medical Council’s (GMC) most recent guidance Decision Making and Consent (GMC 2020). Such information, disclosed during a formal and tangible discussion, must include: /uni25CF the condition and the reasons why it warrants surgery; /uni25CF the type of surgery proposed and how it might correct the condition; /uni25CF the anticipated prognosis and expected side e ff ects of the proposed surgery; /uni25CF the unexpected hazards of the proposed surgery; /uni25CF any alternative and potentially successful treatments other than the proposed surgery; /uni25CF the consequences of no treatment at all. With such information, patients can link their clinical pros pects to the management of other aspects of their lives and the lives of others for whom they may be responsible. Good professional practice dictates that obtaining informed consent should occur in circumstances that ar e designed to maximise the chances of patients understanding what is said about their condition and the proposed treatment, as well as giving them an opportunity to ask questions and express anxieties. Where possible: /uni25CF a quiet venue for discussion should be found; /uni25CF written material in the patient’s preferred language should be provided to supplement verbal communication, together with diagrams where appropriate; /uni25CF patients should be given time and help to come to their own decision; /uni25CF the person obtaining the consent should ideally be the sur geon who will carry out the treatment. It should not be – as is sometimes the case – a junior member of sta ff who has never conducted such a procedure and thus may not have enough understanding to counsel the patient properly . obtaining informed consent for surgery . It is not good enough just to go through the motions of providing patients with the infor mation required for considered choice. Attention must be paid to: /uni25CF whether or not the patient has understood what has been - stated; /uni25CF avoiding overly technical language in descriptions and ex - planations; /uni25CF the provision of translators for patients whose first lan - - guage is not English; /uni25CF asking patients if they have further questions. When there is any doubt about their understanding, patients should be asked questions by their surgeon about what has supposedly been communicated to see if they can explain the information in question for themselves. - Surgeons ha ve a legal as well as a moral obligation to obtain consent for treatment based on appropriate disclosure. Failure to do so could result in one of two civil proceedings, assum - ing the absence of criminal intent. First, in law , intentionally to touch another person without their consent is a battery , remembering that we are usually touched by strangers as a consequence of accidental contact. Surgeons have an obli - gation to give the conscious and capacitous patient su ffi cient information ‘in broad terms’ about the surgical treatment being proposed and why . If the patient ag rees to proceed, no other treatment should ordinarily be administered without fur - ther explicit consent. The second legal action that might be brought against a surgeon for not obtaining appropriate consent to treatment is in the tort (civil wrong) of negligence. Patients may hav e been given enough information about what is surgically proposed to agree to be touched in the ways suggested. However, sur - geons may still be in breach of their professional duty if they do not provide su ffi cient information about the risks that patients will encounter through such treatment. Although standards of ho w much information should be provided about risks vary between nations, as a matter of good practice surgeons should - inform patients of the hazards that any reasonable person in the position of the patient would wish to know . In UK law , this level and style of disclosure has been most recently reviewed in 2 the case of Montgomery v Lanarkshire Health Board. Finally , surgeons now understand that, when they obtain consent to proceed with treatment, patients are expected to sign a consent form of some kind. The detail of such forms can di ff er, but they often contain very little of the information supposedly communicated to the patient who signed it. Partly for this reason, the process of formally obtaining consent can become overly focused on obtaining the signature of patients rather than ensuring that appropriate disclosure has been pro - vided and understood. It is important for surgeons to understand that a signed consent form is not proof that valid consent has been properly - obtained. It is simply a piece of evidence that disclosure may have been attempted. Even w hen they have provided their sig - nature, patients can and do deny that appropriate information has been communicated or that the communication was e ff ec - tive. Surgeons are therefore well advised to make brief notes ments, especially information about significant risks. These notes should be placed in the patient’s clinical record, perhaps by referring to the disclosure in the letter to the family doctor, copied to the patient. In addition, inf ormation sheets describ ing the generic risks, benefits, complications and alternatives associated with the proposed procedure can be provided. It seems that, soon, a record of dialogue will replace the consent form; see GMC (2020), para. 55. DISCLOSURE PRIOR TO CONSENT

In surgical practice, respect for autonomy translates into the clinical duty to obtain informed consent before the commence ment of treatment. It is easy to underestimate the gap in understanding between 2 a surgeon and his or her patient. How many patients would recognise that unilateral eye surgery might lead to contralat eral blindness? The risks and side e ff ects of many operations are not intuitive, and the surgeon is not in a position to guess how the patient’s plans for employment, leisure and family life may be inadvertently a ff ected by a foreseeable complication. A b udding Olympic gymnast might choose to forego surgery on a quiescent posterior triangle lesion if he or she knew the poten tial consequences of division of the accessory nerve. That is why patients need to be informed, beforehand, so they can choose whether or not to take the risk. To establish valid consent to treatment, patients need to be given appr opriate and accurate information. In England and Wales, the Department of Health’s (DH) Reference Guide to Consent for Examination or Treatment (second edition) should be consulted, together with the General Medical Council’s (GMC) most recent guidance Decision Making and Consent (GMC 2020). Such information, disclosed during a formal and tangible discussion, must include: /uni25CF the condition and the reasons why it warrants surgery; /uni25CF the type of surgery proposed and how it might correct the condition; /uni25CF the anticipated prognosis and expected side e ff ects of the proposed surgery; /uni25CF the unexpected hazards of the proposed surgery; /uni25CF any alternative and potentially successful treatments other than the proposed surgery; /uni25CF the consequences of no treatment at all. With such information, patients can link their clinical pros pects to the management of other aspects of their lives and the lives of others for whom they may be responsible. Good professional practice dictates that obtaining informed consent should occur in circumstances that ar e designed to maximise the chances of patients understanding what is said about their condition and the proposed treatment, as well as giving them an opportunity to ask questions and express anxieties. Where possible: /uni25CF a quiet venue for discussion should be found; /uni25CF written material in the patient’s preferred language should be provided to supplement verbal communication, together with diagrams where appropriate; /uni25CF patients should be given time and help to come to their own decision; /uni25CF the person obtaining the consent should ideally be the sur geon who will carry out the treatment. It should not be – as is sometimes the case – a junior member of sta ff who has never conducted such a procedure and thus may not have enough understanding to counsel the patient properly . obtaining informed consent for surgery . It is not good enough just to go through the motions of providing patients with the infor mation required for considered choice. Attention must be paid to: /uni25CF whether or not the patient has understood what has been - stated; /uni25CF avoiding overly technical language in descriptions and ex - planations; /uni25CF the provision of translators for patients whose first lan - - guage is not English; /uni25CF asking patients if they have further questions. When there is any doubt about their understanding, patients should be asked questions by their surgeon about what has supposedly been communicated to see if they can explain the information in question for themselves. - Surgeons ha ve a legal as well as a moral obligation to obtain consent for treatment based on appropriate disclosure. Failure to do so could result in one of two civil proceedings, assum - ing the absence of criminal intent. First, in law , intentionally to touch another person without their consent is a battery , remembering that we are usually touched by strangers as a consequence of accidental contact. Surgeons have an obli - gation to give the conscious and capacitous patient su ffi cient information ‘in broad terms’ about the surgical treatment being proposed and why . If the patient ag rees to proceed, no other treatment should ordinarily be administered without fur - ther explicit consent. The second legal action that might be brought against a surgeon for not obtaining appropriate consent to treatment is in the tort (civil wrong) of negligence. Patients may hav e been given enough information about what is surgically proposed to agree to be touched in the ways suggested. However, sur - geons may still be in breach of their professional duty if they do not provide su ffi cient information about the risks that patients will encounter through such treatment. Although standards of ho w much information should be provided about risks vary between nations, as a matter of good practice surgeons should - inform patients of the hazards that any reasonable person in the position of the patient would wish to know . In UK law , this level and style of disclosure has been most recently reviewed in 2 the case of Montgomery v Lanarkshire Health Board. Finally , surgeons now understand that, when they obtain consent to proceed with treatment, patients are expected to sign a consent form of some kind. The detail of such forms can di ff er, but they often contain very little of the information supposedly communicated to the patient who signed it. Partly for this reason, the process of formally obtaining consent can become overly focused on obtaining the signature of patients rather than ensuring that appropriate disclosure has been pro - vided and understood. It is important for surgeons to understand that a signed consent form is not proof that valid consent has been properly - obtained. It is simply a piece of evidence that disclosure may have been attempted. Even w hen they have provided their sig - nature, patients can and do deny that appropriate information has been communicated or that the communication was e ff ec - tive. Surgeons are therefore well advised to make brief notes ments, especially information about significant risks. These notes should be placed in the patient’s clinical record, perhaps by referring to the disclosure in the letter to the family doctor, copied to the patient. In addition, inf ormation sheets describ ing the generic risks, benefits, complications and alternatives associated with the proposed procedure can be provided. It seems that, soon, a record of dialogue will replace the consent form; see GMC (2020), para. 55.