EDITORIALS:
Patient consent—decision or assumption?
Elwyn (7 June 2008)
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Patient consent—decision or assumption?
Re: creep before climb |
11 June 2008 |
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Laura Hair, Salaried GP Pinfold Surgery, Methley, LS26 9AB
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Re: Re: creep before climb
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There seems to be an assumption within this article that consent is a
less formal process in primary care. Although standards will vary from
surgery to surgery, it seems unfair to imply that the process is less
vigorous than in the hospital setting. If anything, the patient is much
more likely to have consent taken from the person actually performing the
procedure, rather than a hospital junior. The setting may be different,
but primary care doctors still follow GMC guidance.
Competing interests:
None declared |
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Patient consent—decision or assumption?
Media&Politician; Subservient GMC |
11 June 2008 |
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Harold Bourne, Private Practice Rome Italy
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Re: Media&Politician; Subservient GMC
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Guidelines betray ignorance of,if not indifference to the
psychological needs of seriously ill people.They are usually anxiously
dependent,awaiting medical rescue,or even magic,with no appetite for
earnest clinical debate.It is realistic to understand this instead of
leaning over backwards against paternalism.The GMC,scared of media scandal
and of being disempowered by populist politicians,is remarkably lacking in
any solidarity with the rest of us out at day and night work in the actual
field .. hence these oh so solemn guidelines..
Competing interests:
None declared |
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Patient consent—decision or assumption?
Informed Consent: Of course, we MUST do better. |
11 June 2008 |
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Philip Harrison, General Practitioner New Zealand
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Re: Informed Consent: Of course, we MUST do better.
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Professor Elwyn's thesis may create more problems than answers and create dichotomy in the appropriate use of the written word, but informed consent, is a well worn track and an established province of clinical (therapeutic) trials. If we mistrust the pharmaceutical industry so much what is so perfect about our own profession (whom collaborate so closely). So what is so difficult? Surely, communication to patients is more important than our own desired endpoints as clinicians? If we cannot take the patient with us in our medical philosophy, are we fit to be their doctors? And, if documentation is "bureaucratic" then so be it. We are in a progressively accountable world and doctors (and other health care workers) are not in a position to know what is right from knowledge alone. What about the patients belief systems? Is it our place to question them even if we vehemently disagree? No we are THEIR servants, they are not ours. We advise them. They accept or reject. And we record what they understand and accept what limitations this process may have. Limited yes! But better than nothing! And, where the alternative could well be confusion, collusion and unethical behaviour. Yes, we may all mean well but IS THAT ENOUGH? The GMC is scraping the surface of a minefield. Underneath are the skeletons of deceit, misinformation, miscommunication, paternalism, arrogance, incompetence, misguided benevolence and 'professionalism'. Yes, and most of us try to be good doctors. And we all fail. To err is human. Excellence must acknowledge this. Written proof of understanding, even prior to a simple general anaesthetic, for example, allow us busy people to stop and think and say, "what if it was my sister?". What if they do not understand they could die? The publications of Goodyear-Smith *1, following on from Paling*2 and Gigerenzer*3 show we communicate very poorly what evidence supports our intentions. We doctors are also creatures of habit and we need to be more accountable in our own medical belief systems.
The GMC have not really done enough but, perhaps, the process has started and I wait with baited breath as it all evolves into our 'Brave New World' which we appear to fear.
Philip Harrison
General Practitioner
Upper Hutt Health Centre,
Wellington,
New Zealand
*1 "Patients Prefer Pictures to Numbers to Express Cardiovascular Benefit From Treatment" Goodyear-Smith F; Arroll B, Chan L; Jackson R; Wells S; Kenedy T: Annals of Family Medicine Vol 6, No 3, May/Jun 2008
*2 "Helping Patients Understand Risk" Paling J. BMJ, 2003; 327 (7417): 745-748
*3 "Simple Tools for understanding Risks"; from innumercy to insights. BMJ. 2003; 327 (7417); 741-744
Competing interests:
None declared |
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Patient consent—decision or assumption?
The patient's agent |
11 June 2008 |
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Tom H Hughes-Davies, Retired paediatrician SP6 2EJ
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Re: The patient's agent
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The patient is asking for help, not submitting to another's decision.
We should use request rather than consent forms to make this clear.
Competing interests:
None declared |
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Patient consent—decision or assumption?
Who does it? |
11 June 2008 |
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Daniel Garros, Associate Professor of Pediatrics, Pediatric ICU staff Stollery Children's Hospital, Edmonton AB, Canada T6G 2B7
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Re: Who does it?
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One interesting aspect not addressed in the article about obtaining
consent is "who" should obtain it?
Within the critical care environment (CCU) for example, procedures done
by radiologists and surgeons outside the actual unit are a constant. It is
not uncommon that the CCU physician is asked, as the patient is leaving
the unit, to quickly obtain consent from families.
If I am not actually the physician doing the procedure, should I obtain
consent for it?
Should a nurse, in charge of the radiololgy department that day, obtain
consent? Should a doctor in training (resident, fellow, junior registrar)
obtain consent in behalf of his supervisor?
Informed consent becomes a formality, without real meaning, if the person
doing the procedure is not the one obtaining it!
Surely this issue is a practical one, and it needs to be properly
addressed by hospital administrators.
Competing interests:
None declared |
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