From the Patient’s Perspective: Is There a Need to Improve the Quality of Informed Consent for Surgery in Training Hospitals?

Abstract

The current informed consent process in use in the surgical training program at the University Hospital of the West Indies requires improvement to meet expected ethical and legal standards.

Healthy subjects’ knowledge of surgical complications: a hospital-based survey

“…It is hard to decide how many details should be given to a patient who is about to undergo a surgery, especially one with a high risk of failure or adverse side effects. Although there are a number of guidelines, the issue of how much to explain to a patient undergoing surgery is still unclear (4,7,11,12). There are some serious complications that are extremely rare and not routinely mentioned by some doctors, who know that a reasonable patient can have doubts and even decline the procedure after learning all the risks they are accepting by having the surgery (7).…”

“…According to the law, the patient must be informed about the diagnosis and its uncertainties, the purpose, benefits and risks of the recommended treatment, other treatment choices and their benefits and risks, and potential complications (1,2,(4)(5)(6)(7)(11)(12)(13)(14). With sufficient information, the patient can decide whether or not to go ahead with the surgery, knowing the risks of refusing or accepting the treatment (1,5,13).…”

“…Preoperative patient information should include diagnosis, treatment, risks, and further course of the illness to enable the patient to make his or her own decision on having the surgery (1,2). Since most patients do not know about medical procedures, it is the attending doctor's legal and ethical responsibility to give the information using proper terms (6,7). The informed consent that must be signed by the patient before an operation as a legal requirement is, therefore, an important factor for medical care to be effective (8,9).…”

“…Too much information about potential surgical complications can lead a minority of patients to have doubts and even decline the operation; alternatively, too little information fails to adequately inform patients before they sign the informed consent form (4,7,10,11). In some cases, the surgeon may prefer not to mention serious or frequently occurring risks that may cause a reasonable patient to decline the surgery (4).…”

“…In some cases, the surgeon may prefer not to mention serious or frequently occurring risks that may cause a reasonable patient to decline the surgery (4). The general practice is to inform patients about the risks that can occur with greater than 1% frequency; sometimes, less frequent risks that can cause serious health problems are not mentioned at all (7).…”