Instilling confidence and giving fair warning

As a trained health professional, you have confidence in your ability to provide quality clinical care to your patients and see the positive results of your intervention on a regular basis. However, you also would know that there are no guarantees in life and that responses to your care can vary from person to person. Finding the right balance between showing confidence in your approach to a patient’s care and giving fair warning of any risks likely to be associated with that care, is the first step to obtaining informed consent from your patients.

Communication is a two-way street

When obtaining informed consent there are two types of risk that need to be canvassed with the patient, those risks that are common but slight and those that are rare but serious.

Practice working into your conversation the risks that your professional care may involve without creating unnecessary fear. For example, “There are many documented benefits to this care path but as with anything there are some risks that, although unlikely, I would like you to be aware of”.

Written consent from the patient can be useful but it should be noted that obtaining informed consent is a more involved process than simply obtaining a signature on a form. The onus is on you as a practitioner to ask the right questions and to respond in lay language so that you are understood by the patient.

In the process of obtaining informed consent you would want the patient to understand:

• The nature and likely prognosis of their condition.
• The options available for additional diagnosis and confirmation of the condition.
• The care options available, the approaches and their benefits.
• Warnings with regard to the degree of uncertainty of an outcome.
• Warnings regarding possible adverse outcomes (as noted above).
• Time and cost involved in their care, and any aspect of their care that may be especially costly or protracted.

In many circumstances, dissatisfaction arises from the level of costs, or the lack of communication, rather than the patient outcome. It is desirable that patients are informed of costs prior to proceeding with your care, preferably in writing if the professional care is extended over a number of consultations.

If there is a change in the care plan, obtain and document consent once again. For practitioners in a multidisciplinary practice, obtain and document consent even where the care you provide is one part of a larger program.

Disclose material risks

Material risk means “risk for the individual”. The materiality of risk differs greatly between patients. For example, a pianist will place a higher importance on any risk to their hands and fingers, and a sportsman, who’s physical wellbeing is their livelihood, can be expected to have a closer interest in the outcome than an office worker.

The exact risks and benefits and the detail of explanation required will differ with each patient and each procedure. Risks that might if known cause the patient to decline the care you recommend, must always be explained and recorded along with the patient’s response.

Keep it on the record

You need to remember that in a legal setting what you say you said, means very little. What you documented that you said, means a lot. It is no secret that sound communication and full documentation are the keys to achieving informed consent.

Visit Riskequip and take the Self Check Q&A for Consent to self-assess your management of risks relating to consent.