Consent
Inexperienced doctors should not feel pressured to do anything beyond their knowledge, experience and competence and this includes being asked to obtain consent for a procedure that they are not familiar with. The Medical Council make it clear that interns should not usually be asked to obtain consent unless the procedure is a minor one with which they are familiar. If you are unsure about what is involved in a procedure, even if it is a minor one, you should get a senior to explain or demonstrate it as part of training before ever agreeing to take consent for it from a patient.
Consent is a process, rather than a form-filling exercise. The ethical and legal rationale behind this is to respect patient’s autonomy and their right to control their own life and what happens to their own body.
Failure to take consent properly can lead to medicolegal problems including complaints, claims and disciplinary proceedings. If your actions are scrutinised by the Medical Council you’ll need more than a signature on a consent form to fight your corner.
Interns should not usually be asked to obtain consent unless the procedure is a minor one with which they are familiar
Survival tips
- Always act in your patient’s best interests.
- If you take consent, record in the notes what the patient has been told.
- Use your common sense – consent is patient-specific and depends on the individual’s circumstances, including age, lifestyle, occupation, sporting interests, expectations etc. It may well be that you are not in a position to advise fully eg, a professional athlete.
- Patients are presumed competent to consent unless proved otherwise.
- Any competent adult can refuse treatment.
- Where an adult patient is deemed to lack capacity to make decisions, reasonable steps should be taken to find out whether any other person has legal authority to make decisions on their behalf. If so, the team should seek that person’s consent to the proposed treatment.
- If no other person has this authority, your senior colleagues will have to decide what action to take, taking the patient’s best interests into account.
- A judgment that a patient lacks the capacity to make a particular decision does not imply that they are unable to make other decisions in the future.
Scenario
Dr U is in his first week as an intern in surgery. He is sitting at the desk in the ward filling in forms, when a nurse tells him that there is a patient going to theatre, within the next few minutes, who seems to have the consent form missing from his notes. She insists that the consultant "will get very cross” if the patient turns up in theatre without all the appropriate documentation.
Dr U explains that he has never consented a patient before, and doesn’t think he should do it, but, the nurse insists that “it is only a gastroscopy, not rocket science”
The nurse mentions that the patient’s procedure has already been cancelled once, and it would be terrible if it happens again. Dr U explains that he has never consented a patient before, and doesn’t think he should do it, but, the nurse insists that “it is only a gastroscopy, not rocket science”.
Dr U rightly ignores the pressure, and hurries to theatre to ask one of his senior colleagues for advice. His colleague takes the patient’s consent himself so that there is no delay and makes sure that the consultant demonstrates the procedure to Dr U so that he understands what is involved.