Consent (medicolegal perspective)

Consent (medicolegal perspective)

Feb 19, 2019 0
medicolegal,onthepods

James chats to Georgie Haysom and Jane Ingham about consent and the medicolegal perspective on obtaining informed consent as a Junior Doctor with a shared decision-making approach.

Summary Writer:  Emily Qian

Script Writers:  Georgie Haysom & Jane Ingham

Editor:  Georgie Haysom

Interviewees:  Georgie Haysom & Jane Ingham

About Georgie Haysom

Georgie Haysom (BSC, LLB (Hons)), LLM (Bioethics) is the Head of Advocacy at Avant, Australia’s largest medical defence organisation, and in that role works to improve the legislative and regulatory environment for members and the healthcare system as a whole.

She has worked in health law for nearly 25 years, assisting and advising doctors on a wide range of medicolegal issues, including several years representing doctors in medical negligence litigation. Georgie has a long-standing interest in the interaction between law, medicine and ethics, and the way in which the law impacts on medical practice. She has a Bachelor of Science (Pharmacology), Bachelor of Laws (Hons 1) from the University of Sydney and a Master of Laws specialising in bioethics from McGill University.

About Jane Ingham

Jane is a Senior Medical Advisor in Avant’s research, education and advocacy team.

Jane is a physician with specialty training in palliative medicine. Over many years she has been extensively involved in clinical palliative care, education, quality improvement and research. In addition to working at Avant, she currently holds the position of Associate Director of Clinical Governance – Advance Care Planning St Vincent’s Health Network Sydney. In this, and various other roles, Jane has been responsible for quality improvement and educational activities – working with medical students, residents, nurses and allied health professionals, and with senior hospital and community clinicians from a wide array of medical and surgical specialty areas.

Jane holds academic appointments at UNSW Sydney in Medicine at the St Vincent’s Clinical School, and at the School of Medicine, University of Notre Dame, Sydney Campus and is actively involved in teaching and the supervision of research.

Consent (medicolegal perspective)

With Georgie Haysom, Head of Research, Education and Advocacy (Avant) and Dr Jane Ingham, Palliative Care Specialist, Senior Medical Advisor (Avant)

Introduction

Obtaining patient consent is a commonly required practice for all doctors at some stage in their career. Although specific hospital guidelines determine the minimum level of training required to engage in the consent discussion, there are times when junior doctors may be required to obtain consent. This process requires a patient-centred approach as well as sound communication skills to allow an open and thorough discussion which will inform patients of their management options in the context of their values.

Georgie Haysom, the Head of Research, Education and Advocacy of Avant and Dr Jane Ingham, a palliative care physician and Senior Medical Advisor at Avant explore the important medico-legal aspects of obtaining consent. They focus on junior doctors’ role in the process and some case examples commonly encountered by young doctors.

  • Obtaining consent is a medicolegal requirement and is required before undertaking an examination, investigation, procedure or treatment (except in cases of life-threatening emergencies) (Avant, 2018)
  • Consent may be implied (e.g. a patient offering their arm for IV cannulation), verbal or written
  • Written consent is required for certain procedures and treatments (including most surgical interventions, blood transfusions and chemotherapy) – the requirements are outlined in hospital policies and legislation
  • An action should never be undertaken if patient consent has not been obtained unless it is an emergency situation
  • While the process of obtaining consent can be delegated, the doctor undertaking the procedure, conducting the examination or initiating treatment remains responsible for ensuring that the patient has provided a valid consent
  • The doctor obtaining consent should have sufficient skill and competence in understanding all information to be disclosed and be at a level of training in keeping with local policy guidelines for engaging in consent discussions
  • Voluntariness
    • Patients must give consent free of coercion or undue influence
  • Capacity
    • Patients must have the ability to understand, retain, and evaluate information relevant to the consent
  • Disclosure
    • All relevant information must be provided to the patient, including proposed treatment and intended outcome, associated risks and complications (including those that are material to the particular patient), and alternative options and outcomes which may occur if no intervention is pursued. Information regarding specific procedural details including for example, who will be performing the procedure and their level of training should be disclosed
  • A patient-centred approach is recommended, that is, an approach that serves to allow areas of specific importance to individual patients to be discussed thus giving the patient an optimal framework for decision making
  • Ask open-ended questions to stimulate discussion and identify specific patient values and concerns
  • Patient consent should ideally involve a discussion which occurs over several consultations to allow the patient time for reflection and the opportunity to pose more questions
  • While using checklists to cover complications associated with an intervention can be helpful to guide discussion with a patient, they can be unengaging and impersonal, and can fail to take into account a patient’s specific circumstances
  • If conservative treatment is proposed as an option for the patient, ensure that the patient knows they will be provided with ongoing support and treatments such as symptom relief and rehabilitation – aim to ensure they don’t feel “nothing can be done” or that they are being abandoned
  • Learn to use silence during discussions to allow the patient to process information and feel less pressured to make an immediate decision
  • If the person obtaining consent is unsure how to answer any questions the patient asks, it is their responsibility to source the answer for the patient from a senior or other resource
  • For more complex and risky procedures, more information is required by the patient and the skills and knowledge needed to obtain the consent increase. In such circumstances, a junior doctor may not the right person to obtain the consent.  If you don’t feel comfortable obtaining consent seek advice from your senior colleagues
  • The family of non-English speaking patients should not act as a translator due to a lack of appropriate training, risk of bias and potential conflict which may arise
  • Family may be present during discussions (with patient consent), however, hospital policies may require a trained healthcare interpreter to be consulted
  • Healthcare interpreters are trained specifically to have an understanding of medical terms and experience in translating accurately to prevent miscommunication or loss of information
  • A patient needs to give consent before undergoing an examination, investigation, procedure or treatment – except in the event of a life-threatening emergency
  • Obtaining consent is a process requiring a patient-centred approach which can benefit from multiple consultations depending on the nature of the procedure
  • Patient consent involves a teamwork approach and requires junior doctors to enquire and learn about certain procedures, risks and complications so they can conduct effective consent discussions
  • Patient consent is a medico-legal requirement and only doctors with sufficient skill, competence and at a level of training in keeping with local hospital policy should engage in consent discussions

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Tags: #Avant,#consent,#consent from a medicolegal perspective,#documenting consent,#implied consent,#informed consent,#medicolegal,#shared decision making

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