Informed written consent for surgery is routinely undertaken in most hospitals around the world prior to most procedures except the most dire emergencies.
Informed consent is, of course, different to and of a higher standard than general medical consent. The Informed Consent article in Wikipedia gives a good idea of the distinction between the two. en.wikipedia.org/wiki/Informed_consent
Let us think about consent for elective surgery. Typically, the actual quality and quantity of information is tailored according to the doctor's perception of the patient's ability to comprehend and analyse complex information. But, how much information is enough for the patient or relative to decide on the best course of action?
In the UK and perhaps in most other developed nations, it is generally agreed that all common complications (such as surgical site infection rates) should be mentioned and in addition any serious complications (death, possibility of intensive care admission, damage to nerves and blood vessels, paralysis) however rare. Written information and suggestions for further reading
It used to be quite common for the consent process to be delegated to "lesser mortals" (read junior doctors - who typically did not have a clue about the actual surgery or the potential complications). Due to a combination of fear of litigation and a gradual cultural change in doctors' attitudes, consent is increasingly becoming the responsibility of the operating surgeon. The patient is allowed to think it over and get back to the surgeon once they have decided. The consent process becomes exactly that - a "process" that occurs over a period of time rather than an event involving a piece of paper (form with lots of disclaimers and medical jargon), a pen and an impatient doctor waiting to move onto the next patient.
This is all very well in a public healthcare system such as NHS (UK) where doctors are trusted to act in the best interests of patients.
In India, it would appear to be a different ball game. I cannot imagine that informed consent (at least in its true sense) figures highly in list of priorities of government hospitals. Having never worked in 1 for the last 15 years, I honestly don't know.
In private hospitals, much is made of "signing the piece of paper" without either the patient or the doctor realising the significance of the act. Then there is the question of how much the patient is really told. Having worked for almost a year now in India, I get the impression that the average Indian (paying) patient expects 100% success with 0% complication. Patients are likely to place their confidence in a surgeon who promises this, overtly or otherwise. Aa a shining example of the many paradoxes in India, an honest doctor who explains every eventuality clearly is viewed with greater suspicion than one who brushes aside the details and promises a guaranteed result with no mention of complications.
Having spoken to several colleagues who have been practising in India for some time, it is the general view that it is unnecessary for patients to know every last detail of the surgery. It is a common belief amongst doctors in India that the very word "complication" or "problem" is likely to put patients off.
Doctors rationalise that in the end they recommend surgery in the best interests of the patient and anything that may discourage the patient from undergoing surgery is unwelcome. I remain unconvinced by this argument.
Though organisations such as NABH demand minimum standards for the process of informed consent, the extent to which hospitals are able to comply with such high-minded ideals is questionable. The risk-averse (slightly deluded) Indian patient is to blame at least in part.
All operations carry a risk of complications. The mere act of explaining such risks does not make the surgeon less competent or confident.
Honesty and a clear understanding of the doctor-patient contract are fundamental to delivering the many quality improvements that are desperately needed in Indian healthcare. Doctors need to tell their patients more about what they are likely to experience during and after surgery. Patients, for their part, should demand more information from their doctors about such risks.
Informed consent is, of course, different to and of a higher standard than general medical consent. The Informed Consent article in Wikipedia gives a good idea of the distinction between the two. en.wikipedia.org/wiki/Informed_consent
Let us think about consent for elective surgery. Typically, the actual quality and quantity of information is tailored according to the doctor's perception of the patient's ability to comprehend and analyse complex information. But, how much information is enough for the patient or relative to decide on the best course of action?
In the UK and perhaps in most other developed nations, it is generally agreed that all common complications (such as surgical site infection rates) should be mentioned and in addition any serious complications (death, possibility of intensive care admission, damage to nerves and blood vessels, paralysis) however rare. Written information and suggestions for further reading
It used to be quite common for the consent process to be delegated to "lesser mortals" (read junior doctors - who typically did not have a clue about the actual surgery or the potential complications). Due to a combination of fear of litigation and a gradual cultural change in doctors' attitudes, consent is increasingly becoming the responsibility of the operating surgeon. The patient is allowed to think it over and get back to the surgeon once they have decided. The consent process becomes exactly that - a "process" that occurs over a period of time rather than an event involving a piece of paper (form with lots of disclaimers and medical jargon), a pen and an impatient doctor waiting to move onto the next patient.
This is all very well in a public healthcare system such as NHS (UK) where doctors are trusted to act in the best interests of patients.
In India, it would appear to be a different ball game. I cannot imagine that informed consent (at least in its true sense) figures highly in list of priorities of government hospitals. Having never worked in 1 for the last 15 years, I honestly don't know.
In private hospitals, much is made of "signing the piece of paper" without either the patient or the doctor realising the significance of the act. Then there is the question of how much the patient is really told. Having worked for almost a year now in India, I get the impression that the average Indian (paying) patient expects 100% success with 0% complication. Patients are likely to place their confidence in a surgeon who promises this, overtly or otherwise. Aa a shining example of the many paradoxes in India, an honest doctor who explains every eventuality clearly is viewed with greater suspicion than one who brushes aside the details and promises a guaranteed result with no mention of complications.
Having spoken to several colleagues who have been practising in India for some time, it is the general view that it is unnecessary for patients to know every last detail of the surgery. It is a common belief amongst doctors in India that the very word "complication" or "problem" is likely to put patients off.
Doctors rationalise that in the end they recommend surgery in the best interests of the patient and anything that may discourage the patient from undergoing surgery is unwelcome. I remain unconvinced by this argument.
Though organisations such as NABH demand minimum standards for the process of informed consent, the extent to which hospitals are able to comply with such high-minded ideals is questionable. The risk-averse (slightly deluded) Indian patient is to blame at least in part.
All operations carry a risk of complications. The mere act of explaining such risks does not make the surgeon less competent or confident.
Honesty and a clear understanding of the doctor-patient contract are fundamental to delivering the many quality improvements that are desperately needed in Indian healthcare. Doctors need to tell their patients more about what they are likely to experience during and after surgery. Patients, for their part, should demand more information from their doctors about such risks.
