15 May 2011

Chris Howse

Expensive Pearls:

Medicolegal Session

Consent

1. Why is consent important?

- It is good practice and a legal requirement in Hong Kong

- Patients are becoming better informed

- Good consent ensures that the relationship between doctor and patient is based on confidence and trust.

2. Consequences of a failure to obtain consent:

- Criminal proceedings.

- Civil proceedings.

- Medical Council proceedings.

- Press.

What is meant by consent?

(1) The patient must be informed of the procedure.

(2) The patient should be competent.

(3) The patient must consent to the procedure.

(4) The consent must be informed.

Can you rely on a consent form?

- Undue emphasis or reliance can be placed on the signing of a consent form.

- A consent form is not proof that the patient has given an informed consent.

- A signature on a consent form is meaningless if the patient is incapable of understanding what is involved in the proposed treatment.

- Getting consent can be time consuming.

Common Myths

- A signed consent form counters any allegation that the consent was invalid.

- Relatives can sign a consent form.

- The 1% rule.

Who should take consent?

- The medical practitioner giving the treatment.

- Can you delegate consent to a more junior member of the team?

Who can give consent?

(1) Adults.

(2) Children.

(3) Patients under a mental disability.

How much information do patients need to enable them to give a valid consent?

The patient needs to be made aware of the procedure and of any potential risk or complication, however rare that risk or complication, which might influence their decision as to whether to undergo the procedure.

Hong Kong Guidelines on the pre-anaesthetic consultation

"Consultation by an anaesthesiologist is essential for the medical assessment of the patient prior to anaesthesia for surgery or other procedures. The main purpose of the consultation is to ensure that the patient is in the optimal stage for anaesthesia and surgery but will also include other aspects of anaesthetic management listed under the recommendations."

Patient's rights and patient's responsibilities

- The right to be informed with a clear, concise and understandable explanation of the proposed care and procedures including alternatives and common side effects and risks.

- The right to receive medical advice and treatment which fully meets current accepted standards.

- The responsibility to inform the doctor fully of all relevant medical history.

General principles

(1) The pre-anaesthetic consultation should wherever possible be performed by the anaesthetist who will administer the anaesthetic.

(2) The consultation should take place at an appropriate time before anaesthesia and surgery to allow adequate consideration of the factors involved.

Pre-anaesthetic consultation should include:

(1) Identification of the patient.

(2) A concise medical history and clinical examination of the patient.

(3) Confirmation with the patient of the nature of the procedure and their consent to anaesthesia.

(4) A discussion with the patient of those details of the anaesthetic management which are of significance to the patient.

(5) Consultation with colleagues in other disciplines, where appropriate.

What information is important?

"A person is entitled to know the implications of an anaesthetic before it is administered and to seek clarification of any issues which may be of concern. The person must be free to accept or reject advice."

Important Principles

(1) Information about the proposed anaesthesia should be provided in a way that the patient is able to understand.

(2) Alternatives.

(3) Questions should be encouraged and answered clearly.

(4) Where a patient does not wish further information.

(5) Known risks should be disclosed.

Examples of risks which are given in the guidelines include:

(1) Common adverse effects of general anaesthesia.

(2) Less common, but not rare, adverse effects.

(3) Rare adverse effects.

(4) Adverse effects which are related to pre-existing disease.

How do you present the information that the patient needs? (1) Consider whether an interpreter is necessary.(2) Use visual aids, leaflets and other publications. (3) If it helps, suggest that the patient brings a relative or

friend to the discussion.(4) Ensure that distressing information is given in a

sensitive way.(5) Involve other members of the healthcare team in the

discussion, where appropriate.(6) Answer any questions fully and honestly.(7) Give the patient plenty of time to understand the

information.

How do you know if the patient has given a consent?

Implied consent

Express consent, especially where:

- The treatment or procedure is complex or involves significant risks.

- There may be significant adverse consequences for the patient's employment or personal life.

How long does consent last?

Refusing consent

Withdrawing consent