Teaching: Informed Consent

Casebank Combined
1

Where are you:
You are FY2 in the Surgery department.

Who is the Patient:
A 3rd year medical student, Harrold Foster, wants to learn about the informed consent.

Task:
Teach him and address his concerns.

Concerns:
1.How do we get consent before any surgical procedure?
2.Should it be in written form?

Introduction and ID Check:

Hey, You must be Harrold, right?
Could you please confirm your full name?
I am XYZ,one of the FY2 doctor working in the surgery department.

Build Rapport:

Ask couple of questions for rapport. Have we ever met before?
How’s the study going?
Any exams coming up?
How are you finding the teaching centre?

Main Concerns:

Max,How can I help you? Or I understand that you are here to learn something,is that correct?
-Yes, could you please teach me about the informed consent?
-Yes,definitely I would love to teach you about that and I really appreciate that
you are already filled with so much enthusiasm…(Acknowledge and IPS)

Assess knowledge:

-So before we start could you tell me What is consent ?
: permission before any time of medical treatment,test or examination.
-What exactly you want to know in particular?- Informed consent before any surgical procedure
-Why do you want to know about it,any reasons in particular?

Teaching :

Harrold, as we already mentioned consent is a permission before any medical treatment,tests or examination, but do you know who gives consent to whom?

Consent is given by patient to any health care personnels eg. Nurse arranging a blood test,surgeon planning an operation etc.

For a consent to be valid,it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

  • Voluntary: the decision to either consent or not to consent to treatment must be made by the person and must not be influenced by pressure from medical staff,friends or family.
  • Informed : the person must be given all of the information about what the treatment involves, including the benefits and risks,whether there are reasonable alternative treatments and what will happen if treatment doesnot go ahead.
  • Capacity : the person must be capable of giving consent,which means they understand the information given to them and can use it to make an informed decision.

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment,their decision must be respected.This is still the case even if the refusing treatment would result in their death.

If a person doesn’t have the capacity to make a decision about their treatment and if they haven’t appointed the lasting power of attorney(LPA) : decision to treatment should be in person’s best interest.

Harrold, Do you know how do we take consent in Child and young people?
-If they are able to,consent is usually given by patients themselves.
-But someone with the parental responsibility may need to give consent for a child upto 16 years age.

How consent is given?
Verbal: for minor tests and examinations: eg a person saying they’re happy to have
an Xray, blood sampling
Written: for surgical procedures: eg signing a consent form for surgery

When consent is not needed:

  • emergency treatment to save patient’s life,but they are incapacitated eg if they are unconscious)- reasons can be explained once they have recovered
  • when there is an additional emergency procedure during an operation : eg tear in major blood vessel like aorta during abdominal operation
  • treatment of severely ill patient living in unhygienic condition

Adress the concerns

  • pause and check for the understanding
  • offer links to NHS website for more information
  • offer him to come back if he has any furthur question.
12 Likes
2

INFORMED CONSENT- Teaching
A medical student wants to learn about informed consent. Teach him

Scenario A
when do we take verbal consent?
What is mental capacity?

Scenario B
When do we take written consent?

APPROACH
GRIPS
Paraphrase
I understand you want to learn about informed consent.
IPS- commend him for his/her knowledge seeking behaviour. Thank him/her for approaching you and assure him/her you’ll try your best to put him through.

Then ICE the medical student using 2 key questions
What do you know about informed consent ?
Is there anything in particular you’ll like me to teach you?

Then start your teaching proper
Define consent:
Consent simply means permission taken from a patient before an examination, investigation or treatment is being carried out.

Check for understanding

Types of consent:
Verbal- consent form doesn’t need to be signed eg before requesting or doing an xray
Written- consent form needs to be signed eg before surgery or a procedure
Non-verbal eg holding out an arm before a procedure

Check for understanding again

When do we take consent?
Consent is taken in the following situations

  • performing physical examination
  • test
  • procedures
  • taking or using clinical photographs of a px
  • disclosing patient’s info to others eg relatives
  • clinical research

Check for understanding again and ask for concerns.

Criteria for a consent to become valid
For a consent to be valid, it must fulfill the following criteria.

  1. It must be Voluntary
  2. It must be Informed
  3. Patient must have mental capacity

voluntary – the decision must be made by the patient without any external influence from medical staff, friends or family

informed – the person must be given all of the information about his treatment, including the benefits and risks, whether there are reasonable alternative treatments, and consequences of not receiving such treatment.

Mental capacity- this means the person understands & remembers/retains the information given to him/her and can use it to make an informed decision.
It is assumed every adult has capacity.
Once patient has capacity, you must respect their wishes.
U ( understand) R( retain) well ( weigh) Come ( communication)

Ask for concerns again

What if patient doesn’t have capacity eg unconscious px, severe mental illness?
Then Check for lasting power of attorney.
If no LPA, HCPs can treat if its in the best interest of the patient.

NB:

  1. You must cover criteria for a consent to be valid
  2. You must address the student’s concerns. If he wants to know when verbal consent is taken, then list the following:
    -examination
    -test eg xray, blood test
    -Simple procedures eg Lumbar puncture, chest tube, suturing minor lacerations
    -pictures
    -disclosing information to relatives

If it’s scenario B when the student asks for written consent, then mention the following: -surgery
-complex medical tests and procedures eg endoscopy
-research
-radiotherapy

Once it’s two minutes remaining and you’ve not covered the station, make plans to arrange for another discussion or meeting.