Preface

Patients have the ethical and legal right to decide whether to undergo medical or surgical intervention. Before this can occur, they need to be provided with sufficient information so that they can make an appropriately informed decision about their care. The amount of information given will vary from patient to patient depending on individual circumstances. Valid consent to treatment is vital in all forms of healthcare and extends from simple examination to disclosing confidential information to undertaking major surgery.

The Department of Health has highlighted, for consent to be valid, the patient must be fully informed of the risks, benefits, and alternatives to the procedure in question. This is particularly applicable to invasive investigations and surgical procedures. All significant risks should be disclosed and this will vary from patient to patient (significance depends on individual circumstances). Many complaints and medicolegal cases involve inadequate disclosure of the potential risks and benefits of the procedure in question. The information included in this book is not exhaustive: it is neither practical nor possible to list every possible risk for every procedure. Similarly, every possible risk cannot be disclosed during consent.

Also, the consent process cannot be reduced to information contained within a book—it is far more than that. Consent needs to be tailored to each patient as, while a given benefit or risk may not be significant for one patient, it may be greatly significant to another, depending on the circumstances that the patient finds themselves in. Thus, the information in this book is intended to be used as a basis for consent and should be individualized accordingly for the patient concerned.

Several published audits have demonstrated that there is great variability in the quality of consent for surgical procedures. This is at all levels: from foundation year trainees through to consultants. Improving the consent process can only be beneficial to both the patient and the clinician.

Gaining informed consent for individual procedures is a structured process that is often not included in formal medical education. All too often it is the junior surgical trainee who is requested to consent patients for surgery, but who although ‘trained’ to undertake consent is unable to perform the procedure as they do not fully understand all of the significant risks of the procedure. This is poor practice (put yourself in the patient's shoes!). The person taking consent should ideally be the person about to undertake the procedure, as per the Department of Health, General Medical Council, and the Royal Colleges’ guidelines. If this is not possible, consent must be taken, at the very least, by someone who is capable of performing the procedure or someone who has sufficient knowledge of the procedure, techniques, benefits, alternatives, and risks.

Although aimed at surgical trainees, this handbook offers all healthcare professionals general guidance in the principles of consent, followed by procedure-specific information regarding risks and benefits. The aim of this book is not to ‘teach’ consent to junior trainees and is not intended to reduce the need for the person undertaking consent to be able to perform the procedure. Rather, it is intended to be an adjunct to surgical training as a pocket reference for the clinician to help improve the quality and content of verbal and written consent in surgical practice. Thus, we hope this book will help medical staff to discuss surgical treatments with patients, particularly with disclosure, improve understanding of the principles of consent and encourage good consent practice.

RN

DH

March 2011