Irish Medical Organisation

Latest IMJ: Study at Cork University Hospital finds that changes are required in the consent process

Irish Medical Journal Press Release

Irish Medical Journal   SEPTEMBER 2011 ■ Volume 104 ■ Number 8

A study carried out at Cork University Hospital (CUH) recommends the use of multimedia adjuncts to facilitate both patient and doctor education in the consent process.
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 it is paramount that an effective strategy is developed to improve on current deficiencies. It is the opinions of the authors that this is best served through a combination of pro forma 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 Murphy et al. Several review articles have attempted to provide a general overview of how the obtaining of consent should be done in ideal circumstances, however this poorly translates into the clinical reality. 
The Irish Medical Council’s recommendations (Medical Council. A Guide to Ethical Conduct and Behaviour, 6thEdition, 2004) on the area of documentation are brief, but advocate that all details of the discussion be recorded in the medical notes of the patient. The General Medical Council of the UK (General Medical Council. Consent: Patients and Doctors Making
Decisions Together. General Medical Council, 2008) explores this in more detail, recommending 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 Medical Council nor the General Medical Council 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 but the final discussion and consent form filling process 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 (NCHD’s).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. No documentation failings resulted in postponed procedures.
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 and it also may not offer the patient an adequate forum to ask questions. It would however, in the elective setting, provide a standardised template for both the patient and the consenting doctor.
A further approach, favoured by the authors, involves improving the education of both doctor and patient through printed or multimedia delivered information. Several authors have attempted this approach. A study by Tait et al showed that the use of a multimedia tool led to a statistically significant increase in patient understanding of the risks of cardiac catheterisation and treatment options.
In Cork University Hospital, a recently developed online multimedia system has improved the clinical experience of patients undergoing parathyroid surgery (paper under review) (Neary et al). Studies have also shown the benefit of written information provision to patients.
The study also reports some of the problems associated with the consent process as it is currently practised in many hospitals. Although a challenging problem to all practising procedure based medicine, it has the potential to affect the efficient running of hospitals, the relationship with patients, the patient experience and the participation in judicial proceedings. 
All references are contained in the full print article on the IMJ website.
For further information contact:
Communications Unit
Irish Medical Organisation
Tel. 01 6767 273

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