Principles of Consent
To consent to any procedure, an individual firstly needs the ability to be able to understand what they are consenting to. There are different levels of consent. Some people may be able to consent at a basic level ie agree to an examination but not to undergo a surgical procedure – children may be a good example.
Every individual’s ability to consent will be taken into consideration by the clinician involved. The clinician will ensure the patient understands the procedure, can retain the information and understand the implications of undergoing the procedure. The clinician will also attempt to gain consent (where appropriate) before embarking on anything which may impact on a patient directly.
Types of consent used within clinical practice:
- Assumed consent
- Informed verbal consent
- Informed written consent
This is used in clinical practice on a daily basis. Certain procedures are carried out by GPs whereby the patient is advised by the GP what they are going to do without further explanation for example taking a blood pressure, looking in the ears, examining a joint.
In addition, when agreeing to a referral to another clinical team, it is assumed that the patient is consenting to relevant information being shared with that team. The information to be shared includes: your name and address, the reason for the referral, your medication, conditions you have been diagnosed with, any details regarding your medical history that your GP believes to be relevant, details of any recent treatment and the name and practice of the referring doctor.
Informed Verbal Consent
A lot of day to day practice will involve this. It is usually relevant to invasive minor procedures, invasive examinations and close contact with the patient. The clinician will speak to the patient before any procedure is carried out giving important relevant information. The practitioner will also explain to the patient:
- What they need to do (the procedure)
- Why they need to do it (the reasons)
- Any side effects / adverse effects that may occur (potential risk)
- Any expected benefits (aims of the procedure)
- Offer the patient the opportunity to ask questions.
Examples will include:
- Injections (immunisations / contraception / other drugs)
- Joint injections / aspirations / cryotherapy
- Close examinations such as fundoscopy
- Intimate examinations – smears, genital/rectal examination, breast examinations
- Other procedures – syringing ears, wound management, dopplers
Various ways of documenting consent can be used dependent on the situation. In many cases, for example minor surgery and travel, the computer system is used to document clinical information and consent.
Informed Written Consent
Some more complicated procedures require the clinician to take written consent. It gives clear information about the procedure, lists important benefits and risks and allows the patient to also have written information if requested.
This is usually required for the following specific situations:
- Insertion of an IUD / IUS
- Insertion of an implant
- Surgical procedures (excision of lesions)
- Any formal research projects
Questions to ask Health Professionals
As we as giving you information, health professionals must listen and do their best to answer your questions.
You may want to ask questions about the treatment itself, for example:
- What are the main treatment options?
What are the benefit of each of the options?
- What are the risks, if any, of each options?
- What are the success rates for the different options?
- Why do you think an operation (if suggested) is necessary?
- What are the risks if I decide to nothing for the time being?
- How can I expect to feel after the procedure?
- When am I likely to be able to get back to work?
You may also want to ask questions about how the treatment might affect your future state of health or style of life, for example:
- Will my mobility be affected?
- Will I still be able to drive?
Will it affect the kind of work I do?
- Will I affect my personal/sexual relationships?
- Will I be able to take part in my favourite sport/exercise?
The Doctor should welcome your views and discuss any issues so they can work in partnership with you for the best outcome.
Standardised practice forms are used for different procedures. A copy of the signed consent is stored and documented on the patient’s medical records.
Written consent is also requested for patient information to be shared with family members or released to external agencies eg. Insurance Companies
Consent to share information with Family or Carers
Consent to release information to a third party e.g. insurance forms