How Informa+on and Consent Help to Manage Complica+on
Prof Dr Recai Pabuccu
Ufuk University Faculty of Medicine Ankara, Turkey
Consent
• Enough +me should be allocated for detailed consent.
• Care for privacy.
• A witness should be also be conserved to elucidate possible long term consequences.
• If possible, addi+onal document like brochures should beHer be used.
Who should take consent?
The person obtaining consent must;
• Be capable of performing the procedure themselves
OR
• Have received specialist training in advising pa+ents about the procedure.
UK Department of Health guidelines Anderson OA, 2007
Validity
For consent to be valid;
• The pa+ent must be competent to take the par+cular decision
• The pa+ent must have received sufficient
• informa+on to make a decision
• The pa+ent must not be ac+ng under stress.
Timing
• It is wiser to obtain informed consent at the +me when the risks and benefits are oUen explained.
• Be sure the pa+ent understand the content !!
• Not on the opera+on day, under stress!!
Content
Sufficient informa+on to make a decision but ALSO;
• The risks and benefits involved
• Any alterna+ve treatments
• The risks and benefits of doing nothing.
Department of Health (UK) advises that a doctor;
• Should warn the pa+ent of anything that poses a substan+al risk of grave adverse consequences
• Should men+on significant risk that would affect the decision of a reasonable pa+ent
• Is under a clear and legal obliga+on to tell the truth if asked a direct ques+on.
Which risks should be men+oned?
• In prac+ce, a complica+on that is likely to occur more than 1% of the +me is oUen men+oned
• Cri+cal knowlegde about more rare
complica+ons should also be men+oned such as;
Permanent loss of vision aUer cataract surgery which is quite rare (4/1000) but cri+cally affects the pa+ents life.
Too liHle informa+on fails to inform, while too much informa+on may lead to confusion.
Do Not Forget that;
Success vs Risks
Besides the risks;
• Poten+al benefits should also be men+oned
• Frequency of success vs frequency of risks !!
Alterna+ve op+ons
should be men+oned highligh+ng the pros and cons.
If the surgery is not performed?
• The long term possibility of spontaneous
resolu+on or worsening of the condi+on and the way surgery may influence this is worth highligh+ng
CONSENT
• Opportunity for guidance to make the decision
• Dispel unrealis+c expecta+ons related to surgery
• Chance to create an open and truscul rela+on ship between Doctor and Pa+ent
SO MAY HELP İN CASE OF OPERATIVE COMPLİCATİONS ARE ENCOUNTERED.
CONSENT
• Good pa+ent educa+on during consent
process is the surgeons chance to create a rela+onship with the pa+ent and make sure that the pa+ent’s expecta+ons are realis+c.
In Summary;
• Qualified consent by a qualified healthcare professional
• Take for the par+cular procedure and appropriate form
• Take before the opera+on day
• Explain;
– Procedure
– Risks but also beneUs – Alterna+ve treatments
– Risks and benefits of delaying – Avoid medical language
– Do not rush for decision
