Informed consent for orthopaedic surgery: a prospective audit

Abstract

A prospective audit of 76 patients undergoing elective orthopaedic surgery was performed. The aim of this audit was to assess how effectively patients are consented at a busy teaching hospital, and to suggest improvements to the process. Evaluates the level of information attained by patients after giving consent and their overall satisfaction with the process by use of a questionnaire. Results demonstrated that patients were often given incomplete information about their management. Despite this, patients themselves felt that the level of information given to them was appropriate, and allowed them to make an informed decision. Suggests the use of written information sheets and Internet Web sites to supplement the provision of information to patients. These modalities will allow patients to access as much information as they desire, while avoiding any potential anxiety due to provision of excess information.

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

“…mark case (Canterbury v Spence, 1972), a Washington, DC, circuit court ruled that a practitioner is obliged to disclose what "a reasonable person would want to know about a treatment before undergoing it." 12 Although both the Natanson and Canterbury precedents serve as guides in modern medicine, [3][4][5][6] many physicians still experience difficulty with the depth of disclosure. On one hand, physicians may want to volunteer all available information so they are not vulnerable to litigation.…”

“…On one hand, physicians may want to volunteer all available information so they are not vulnerable to litigation. 6 On the other hand, many clinicians suggest that patients may become apprehensive and anxious when excessive information is volunteered, 13,14 although this remains unproved.…”

“…On the basis of this Bolam principle, many surgeons inform their patients of risks that occur with greater than 1% frequency. 6 This, however, is only a guide. In 1992, an Australasian court ruled that a physician was negligent for not discussing a complication with a risk of 0.007% during consent for surgery (Rogers v Whitaker, 1992).…”

“…[1][2][3] Three criteria must be satisfied for the process of informed consent to be effective and valid: 1) capacity, 2) autonomy, and 3) disclosure. [4][5][6] Capacity is the clinical term that refers to a patient's ability to understand all information relevant to decision making and any reasonably foreseeable consequences of the patient's decision. [3][4][5] The determination of capacity is a complex, multidimensional task requiring physicians to determine whether patients have properly received, understood, and retained information relative to the specific scenario or decision.…”

Standardised consent forms on the website of the British Orthopaedic Association

“…Inadequate consenting of patients continues in the United Kingdom despite the best intentions of the Department of Health and standardisation of the appropriate forms. [2][3][4] Errors in information and of omission still lead to confused patients, leaving surgeons and Health Trusts open to litigation. A process of consent used nationally and detailing the same complications for each operation may help to facilitate the legal process in that a judge will be aware of the complications stated in a nationally-accepted universal consent form.…”