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As interns go through their inductions this month, it is important that they are aware of and understand relevant guidance that will apply to their practice when they begin their rounds on the wards. Consent is particularly important, and the Medical Council recently released its updated Guide to Professional Conduct and Ethics for Registered Medical Practitioners containing new guidance on gaining consent. In light of this, the below tips may assist intern doctors when seeking a patient’s consent for a procedure:
1. Never obtain consent for a procedure that you are not familiar with.
It is the responsibility of the doctor providing treatment or undertaking an investigation to discuss it with the patient, or to delegate the discussion to someone who is suitably qualified. The Medical Council advises that the responsibility for seeking consent should not be delegated to an intern, unless the procedure is a minor one with which the intern is very familiar and the intern’s medical supervisor has clearly explained the relevant information about the procedure to them.
2. Record in the notes what a patient has been told.
The presence of a signed consent form does not in itself prove valid consent to treatment. Keep contemporaneous notes which record the names of all those present for the discussion; key points discussed and relevant warnings given to the patient; and details of any patient information leaflets or diagrams made to assist the patient’s understanding.
3. Use your common sense.
Consent is patient-specific and depends on the individual’s circumstances, including age, lifestyle, occupation, expectations, etc. The information should be provided in a way that the patient can understand. If you are uncomfortable consenting a particular patient, always discuss with a senior colleague.
4. Ensure you have documented consent for taking photographs and making recordings.
Your hospital may have specific consent forms that should be used or medical photography departments who can guide you through the process. Any audio, visual or photographic recordings where a patient, or their family, are identifiable requires express consent, and the recording should be kept confidential as part of their medical record. The Medical Council’s updated guide acknowledges that in “exceptional circumstances” and where it is necessary for a patient’s care you may take images using your personal mobile device. However such images should not identify the patient, should be kept for the minimum time required and you are responsible for data protection.
5. Remember that patients aged 16 years and over are entitled by law to give their own consent to treatment.
Where the patient is under 16 years, it is usual that the parents will be asked to give consent. The Medical Council makes clear that it is only in exceptional circumstances that a patient under 16 might seek to make a healthcare decision on their own without the knowledge or consent of their parents. If in doubt consult a senior colleague.
6.Remember, for consent to be valid, the patient must have capacity
The starting point in the case of adults is always to presume that the patient has capacity until it is shown otherwise. The Medical Council advises that if an adult patient lacks capacity and there is no-one with legal authority to make decisions on the patient’s behalf, you will have to decide what is in the patient’s best interests. In reaching such a decision, a number of factors should be taken into account, for example, the patient’s past and present wishes, if known, and the views of other health professionals involved in the patient’s care.
7. You must respect a competent patient’s decision to refuse a particular treatment or investigation, even if you think that the decision is unwise.
The law concerning incompetent adults, who are unable to give valid consent, is more complicated. If you are in doubt consult senior colleagues.
8. Allow the patient to give their consent freely.
Pressuring patients into consenting to treatment invalidates the consent. Where possible, patients should be given time to consider their options before deciding to proceed with a proposed treatment.
9. Always remember that consent is a process, not a one-off event.
It is important to maintain a continuing discussion to reflect the evolving nature of treatment.
10. Ideally consent should be obtained well in advance.
This allows time to respond to a patient’s questions and provide adequate information on the procedure that is planned. If you are asked to consent a patient immediately before an intervention and are uncomfortable doing so, you must seek advice from more senior members of the medical team.
While this may seem like a lot to remember during this challenging yet rewarding time, intern doctors must remember that they are not alone. It is OK to ask for help, to talk about issues or seek advice from a senior colleague or Medical Protection.
A version of this article was published in Medical Protection’s New Doctor on July 11.