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Blog:Surgical Consent

From Mediwikis
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For a long time healthcare has very much been “You know best Doctor”. Occasionally that’s right, but increasingly we’re realising that there’s often much more to it.

As a surgical trainee I knew that when I was discussing an operation with patients I often, if I was being honest with myself, didn’t have the information that I would expect if I was the patient on the other side of the conversation. And I wasn’t alone. In fact the variation in what is being told to patients is huge, and it’s leaving them really confused.

Does it matter?

Yes, for lots of reasons.

Firstly, if it was you or your family it would matter to you.

Secondly, truly informed patients behave very differently to those who aren’t fully empowered and involved in their care. They make very different decisions to what clinicians think they will, because we’re surprisingly bad at understanding patient preference. A good example is patients who attended a patient education programme where benefits, alternatives, outcomes, and risks of a undergoing a transurethral prostate resection (TURP) were 40% less likely to decide to have the operation compared to the current level of discussion. 40%! Another is that breast surgeons believe that 71% of patients with breast cancer rate keeping their breast as a top priority, compared to the real figure of 7%. Knowing and addressing that could really change what we do.

Thirdly, current consent practice costs a huge amount of money in legal fees, £6 million of legal costs in England alone last year, purely because of an unsatisfactory consent discussion. And there were lots more cases where poor consent was a factor. Money that could be much better spent.

So what does informed consent mean and how does Surgical Consent fit in to solving the problem? Informed consent is the process of providing patients with all the information to enable them to make an informed decision about how they want to proceed, and in the context of surgery requires an explanation of what the operation involves, the desirable benefits and likely outcomes, and possible complications. Surgical Consent is a healthcare professional facing mobile application which aims to be a comprehensive resource, taking you all the way through from key information about the operation, the risks and benefits of the operation, and what patients should expect during their recovery. From a medical student point of view it will hopefully lead to less standing in theatre wondering what on earth is going on, and also will help with what to look out for in post-op patients on the wards.

What’s interesting from a legal point of view (stay with me!) is how do we know what we should be discussing, what risks are ‘important’? And the reality is that the answer is still a work in progress. For decades we’ve acted on the advice from the ‘Bolam Test’ which said that “If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent” - so the standard was that of a body of like-minded professionals. This however has been thrown out of the window with the Montgomery Judgement which stated that if “a reasonable person in the patient’s position would be likely to attach significance to the risk” - a very different problem.

About Surgical Consent

So how are we at Surgical Consent tackling the legal problem? We’ve been collating the risk profiles using the best published data available and have been validating with a team of registrars and consultants. Importantly however, the clinician having the consent discussion still has to consider the patient in front of them and think a) does this risk profile fit this patient, and b) is there some reason that something else would be particularly significant to this patient should it happen. Clearly for example, someone who has had an incisional hernia after every previous operation is at a higher risk of one occurring this time too.

The last thing to say is that whereas consultants know a lot of medicine, medical students know a lot about technology. Use that fact. There are so many opportunities to make huge differences in health through tech. And there’s a big pot of cash that’s been announced by the government to get ideas off the ground. So get thinking, and more importantly, get doing! And yes, you can learn to code.

We really hope you’re all as excited about Surgical Consent as we are, and we hope to launch UK-wide in around December so watch this space!
Did you know: A patient having bariatric surgery has a 33% risk of developing gallstones during their rapid initial post-op weight loss. Counter-intuitive.

Key Points

  1. Think about patient preference - it might not be what you instinctively think.
  2. Poor informed consent is bad for patients and bad for the NHS’s bank-balance!
  3. Surgical Consent can make things better and will be a great resource for students too.
  4. Start thinking about tech solutions and make them happen!