INTRODUCTION As part of the NHS Plan the UK Department of Health has suggested that both patients and general practitioners (GPs) are written to following hospital consultations. We audited the responses of patients and GPs to this practice.PATIENTS AND METHODS A total of 160 patients in one consultant urologist's clinic were included. The consultant had never routinely copied GP letters to patients. The SpR in the same clinic had routinely done so in previous posts. Patients who had received letters (group A) and those who had not (group B) were asked to complete a postal questionnaire. GPs were also sent a questionnaire to assess their opinion. The responses were analysed.RESULTS Questionnaires were sent out to patients (80 to group A and 80 to group B. From this, 100 (62.5%) responses were received (A 48 [60%]; B 52 [65%]). Of respondents, 81% were male. Overall, 98% of those patients who received a letter agreed with its contents, and stated they would keep the letter and take it to a subsequent doctor's appointment. Of respondents, 83% (A) and 96% (B) had never received a doctor's letter before but 83% (40 [83%, A], 43 [83%, B]; P > 0.05) of respondents would like to receive doctors' letters in the future. some 22 GP practices received and completed questionnaires at a PCT meeting and 74% of GPs agreed with the practice of copying patients their letters. CONCLUSIONS The results of this study suggest that patients should be offered a copy of their letter and that their response should be documented in the notes. This may serve to improve communication with the patient but should not be undertaken without their agreement.

Objectives:To provide guidance about the risks which should be disclosed to patients and documented during the consent process. Methods: The Delphi Consensus Technique was used to decide what constitutes mandatory risk disclosure for three index procedures. Documentation of risk on consent forms was audited and compared to these locally agreed standards. A four stage strategy for change was undertaken following which practice was reviewed. Results: Mean mandatory risk documentation rose from 61.2% (95% CI: 58.1-64.4) pre-intervention, to 78.1% (95% CI: 72.6-83.6) post-intervention (ccc 2 ; P < 0.001). Conclusions: Although we demonstrated some benefit from this simple approach, the need for pragmatic means of achieving and sustaining complete discussion and documentation of risks across all surgical interventions based on universally accepted standards remains.Key words: Informed consent -Consent forms -Disclosure -Delphi technique -Consensus doi 10.1308/1478708041118 I nformed consent is becoming increasingly sophisticated and involves much more than a completed form. 1 The emphasis now focuses on facilitating adequately informed individual patient choice based on their personal values. 2 Comprehensive, relevant, and accurate risk disclosure is, therefore, essential. Towards this end, the Department of Health has recently produced a revised template for the standard consent form. The requirement for specific documentation of potential complications on the form represents a key change to previous versions. 3 Discussion of every conceivable adverse outcome is impracticable. To date, practice has been based on precedents established in British law. Failure to mention a specific risk only constitutes negligent practice if 'a responsible body of professionals, in a similar situation, would have mentioned the risk'. 4 UK courts have since reserved the right to consider whether medical practice is reasonable. 5,6 Looking overseas, the 'responsible body of professionals' standard has been superseded by that of the 'reasonable patient '. 7,8 This correlates with an overall trend towards greater patient autonomy. 9 In future, only risk disclosure meeting a reasonable patient's needs may be adequate.Currently in the UK, the problems are 2-fold. Agreed guidelines detailing what constitutes reasonable discussion of risk do not exist. A marked lack of consensus has been highlighted in various subspecialties. 10,11 Second, the discrepancy between what may be regarded as adequate risk disclosure, and actual practice has been previously highlighted. 11,12 Certainly, an heuristic assessment of current documentation led the authors to suspect that this shortfall in consenting practice also existed within their own department.We set out to improve the quality of risk documentation in the new section of the revised consent form, to ensure that those conducting the process had been adequately prepared, and, in the absence of agreed national guidelines, provide a local professional consensus as to what constitutes a basic discu...

Key Clinical MessageWe report an incidentally diagnosed retrocaval ureter in a 14‐year‐old boy, while evaluating for right‐sided hydronephrosis associated with cryptorchidism. Therefore, we suggest that any significant right‐sided hydronephrosis associated with cryptorchidism may require investigations to exclude this rare anomaly.

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