A patient and a doctor lying hand in hand on the operating table. That was what came to my mind as I browsed ‘Consent: patients and doctors making decisions together’, the GMC’s new guidance. Consent, it rightly says, is a process, and obtaining it is a partnership. But ultimately the dialogue has to come to an end, and then the patient is on his own.
A doctor who has obtained ‘informed consent’ has done her duty. The patient has understood the risks and benefits and thought about what they mean for him, and has made his decision. On paper, it all sounds so very rational. But real life is rarely rational. Can there be such a thing as truly informed consent?
In the bad old days, obtaining consent meant shoving a form under a patient’s nose, months after their outpatient appointment and an hour before surgery. I wonder if what is now shoved is a handful of leaflets, and if so, whether they are provided in a way and at a time that actually helps the patient. Couldn’t an outpatient appointment be offered after the procedure has been agreed but before surgery? That way, once the realities have sunk in patients could talk to the surgeon about their worries: the rare side effect mentioned in the leaflet; waking up vomiting after the operation; who will look after Rover while they are in hospital. Surgeons are not like timeshare salesman; well, not usually, but a cooling off period would probably reduce the number of operations and improve the outcome of those that are performed.