Talking risks

When a patient with Dupuytren’s contracture attended hospital for a fasciectomy, a nurse asked a foundation doctor to obtain their signature on the consent form because the patient had missed their appointment at the consent clinic, and the surgeon had been called to an emergency.

The scene 

She said this would be straightforward because according to the records, the surgeon had already spoken with the patient about the procedure and discussed the risks and benefits.

However, when the foundation doctor met the patient, she seemed anxious about the prospect of surgery and bombarded him with questions about the speed of recovery and likelihood of nerve damage, which would affect her ability to play the piano. Unable to answer the patient’s questions, the foundation doctor excused himself and sought urgent advice from the MDU.

MDU advice

The medico-legal adviser reassured the doctor he had done the right thing by not trying to bluff his way through the conversation. They said it was wrong for someone to delegate this task to him without checking he was suitably trained and competent, had sufficient knowledge of the procedure and the skills to have a dialogue with the patient. While the surgeon retained overall responsibility for obtaining the patient’s informed consent, the foundation doctor would have to take responsibility for his involvement and needed to speak up if he was being asked to practise outside his competence. 

Although the surgeon may have already had a detailed conversation with the patient, the adviser emphasised that consent should be an ongoing process based on meaningful dialogue with the patient, rather than a one-off exercise. The GMC’s consent guidance says doctors should listen to the patient and ask questions to explore their wishes, fears and expectations, and understand what is important to their quality of life. Equally, a patient should have the opportunity to ask questions and discuss concerns and to change their mind at any time.

The outcome

The doctor spoke to an ST4 in the department with experience of the fasciectomy procedure and he agreed to talk to the patient about her concerns.  After speaking with the specialty trainee, the patient signed the consent form and the surgery went ahead without complications.

Following this incident, the foundation doctor resolved to ask more questions the next time he was asked to carry out an unfamiliar task and ensure he had appropriate training and experience.

Learning points 

  • Be clear about the limits of your knowledge when communicating with patients. 
  • Tailor consent discussions to individual patients and focus on what matters to them to ensure they are able to give informed consent.
  • Speak up if you are asked to do something which is beyond your training and competence.
  • Understand the GMC’s seven principles of decision-making and consent and how these apply to your practice. 

This page was correct at publication on 02/07/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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