Communication Module for Obtaining Informed Consent

The basic structure for communication skills remains the same. Recall the mnemonic P I CX3.

Take into considerations of following points during consultation.

CCondition & natural historyExplain the clinical condition & prognosis
OOptions & alternativesNo treatment, conservative, medical, radiological, surgical
Make patients aware of national guidelines on treatment choices
NName of procedureExplain the procedure at an appropriate level for the patient including anesthesia, site of incisions, purpose and benefit of the procedure and likelihood of success. Use diagrams if necessary to ensure understanding.
SSide effects/complicationsMention the specific complications and the more general risks of surgery and ask about previous anesthetic problems. Any
complication of greater than 1% must be mentioned.
EExtra proceduresExample – Drains, NG tube, Bone graft harvesting, Catheter, Stoma formation, Blood transfusion, etc.
NNamed person operatingPlus assistants
TTrial & trainingIf part of a research trial or presence of any students
SSecond opinionA second opinion may be obtained prior to consenting.

If you are unsure of any points, you may need to defer to your consultant – say that you will speak to him and get back to her.

Finally answer any questions the patient may have about the procedure and ensure they are happy to proceed before asking them to sign the consent form.

In addition to completing the consent form, record in writing the details of the consent discussion with your patient. Any discussions around consent with the patient’s supporter and your colleagues should also be recorded in the patient’s notes.

For MRCS part B, procedures which you should be comfortable obtaining consent for include:

  • Colonoscopy
  • Oesophagogastroduodenoscopy (OGD)
  • Laparoscopic cholecystectomy
  • Hartmann’s Procedure
  • Emergency splenectomy
  • Appendicectomy
  • Hemicolectomy
  • Incision and drainage of an abscess
  • Dynamic hip screw for neck of femur fractures

Example of obtaining informed consent for OGD, dilation and biopsy (Taken from Dr. Tourky Notes):

Hello Mr……., I am……. One of the surgical doctors, I have been asked to talk to you about an investigation we would like to arrange for you.

Can I ask you what do you know so far about this?

Ok, this is what we call oesphageogastrodudonoscopy which can be abbreviated to OGD. The camera is called the endoscope which will be inserted through your mouth down to your food pipe then to your stomach then along the first part of your small bowel. This camera will relay the image to a TV screen so we can have a look inside. We shall also make a widening of the narrow part of your food pipe which was discovered previously on the barium image. We may also take some samples from the lining of your food pipe which may help us in figuring out your case. This will be typically under sedation which will make you slight drowsy and feel no pain.

No procedure is without risks. The possible risk may include:

  • Risks of anesthesia
  • Damage to your teeth from the introduction of the scope
  • Infection such as chest infection
  • Bleeding from the sites of tissue samples
  • The most serious risk is cutting through your food pipe wall which may need a surgical repair

Listing those risks doesn’t mean that they will essentially happen.

My advice is to accept doing this investigation as it is very crucial in determination of your case. Also, you have to know that only skilled and experienced surgeons are the only allowed to perform such procedures.

This is most probably due to the narrowing present inside your food pipe which hinders your regular secretions to flow downwards smoothly.

Still early to confirm that, we will have to wait until the results of this investigation appear and probably we may need to do further investigations to figure it out.

It usually appears within 2-week time frame, I can understand your apprehension and will make sure to contact you once it is available.

Close the consultation, ask if patient has any questions.

Thank the patient.

Sign the consent form.

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