More than a signature, more than a form
Despite how it can often feel in the middle of a busy clinic, or at the start of a full theatre list, consent is more than obtaining a signature on a piece of paper. It is a process that is part of patient-centred care and begins with finding out what matters to the patient, identifying what options are reasonable – including the option of no treatment – and helping the patient decide which option suits them best.
The decision the patient makes may not be the one that you would have made but, if the patient has been kept at the centre of the process, it should be the right one for that individual patient at that time. When the moment comes to sign the consent form, if a patient has been fully involved in the process and enabled to weigh up the different options and their benefits and risks – risks that must be transparently presented – then truly informed consent will have been given. Our approach to consent has to be individualised for each patient and it is with this in mind that we present resources that can aid you in moving towards practising in this way.
With the announcement of the ruling in the Montgomery case, the Supreme Court brought consent law up to date with the approach of modern patient-centred clinical practice, an approach that clinicians had already widely adopted. This was soon followed by the publication in 2016 of the first Realistic Medicine report by the Chief Medical Officer in Scotland. Both of these support and promote the importance of high-quality personalised interactions with patients. The only way that we can know what will be material to a particular patient is to talk to them, to ask them and, most importantly of all, to listen to them.
Consent needs to be viewed as a process that sits within patient-centred care and not as a separate paperwork exercise. When care is delivered collaboratively, the satisfaction levels increase for both the patient and the clinician . In order to practise in this way, it requires each of us to think about how we interact with patients and how we can use our communication skills to aid and support people to make decisions. Teamwork and multidisciplinary working is core to modern clinical practice and now we should perhaps expand that team to include the patient.