Consent is the giving of permission prior to a medical intervention. A signed consent form is not proof that the consent given was valid. In order for consent to be valid, a number of criteria must be fulfilled;
- It must be given before the procedure/intervention – the earlier the better.
- The procedure must be clearly understood by the patient – the indication, how the procedure is performed, risks, benefits and alternative options.
- It must be voluntary – i.e. not under duress.
- Patient must have capacity.
- It is advisable to write what you have discussed with the patient in bullet points on the form
A substantial proportion of medical negligence claims arise from failure to obtain valid consent. Remember, consent can be withdrawn at any stage.
Often, the job of obtaining consent falls to the Intern. You should only obtain consent for straightforward procedures that you understand sufficiently (OGD/ colonoscopy). Do not attempt to obtain consent for procedures that you do not fully understand or are complex in nature (cholecystectomy, bowel resection, hip replacement). If uncertain, consult uptodate. It is the responsibility of the surgeon/physician performing the procedure to obtain informed consent.
Don’t be pressured for consent in complex procedures.
No person can give or refuse consent on behalf of an adult who lacks capacity unless they have specific legal authority to do so. Always inform senior members of your team if any issues arise.
Tips
- Avoid jargon – communicate based on the patients level of understanding.
- Write the complications you have discussed with the patient at the top of the consent from.
- Children over 16 can consent to treatment.
- Refusal of treatment in those under 18 is a grey area.
- If a patient cannot sign, an entry into the medical notes is sufficient.
- All significant risks must be disclosed(i.e. a risk that a patient would attach significance to) – even rare side effects must be mentioned.
- Some patients will decline detailed information about a procedure, especially complications – make sure you document this.
- Check Queensland Government Official PDFs online as a resource.