Surgical consent: the world's largest Chinese Whisper? A review of current surgical consent practices

Abstract

As the law around surgical consent continues to evolve, surgeons and those in training risk being caught red-faced and defenceless. Despite repeated concerns regarding surgical consent being raised by the General Medical Council of the UK, how much is changing on the National Health Service shop floor? This report investigates the variation between consenting practices for six common general surgical operations in 123 individual operations. Results showed that only 20% of mentioned operative complications for each operation were being documented on >75% of consent forms. The vast majority of mentioned complications were mentioned inconsistently, leading to patients being given grossly varying information preoperatively. Reassuringly, only 4.1% of consent procedures were done by those not in core surgical training (junior resident) or above, but nonetheless significant omissions were observed. When consenting a patient for an emergency exploratory laparotomy, an operation carrying a 14% chance of death, a risk of death was only documented in 28% of cases. Trainees failed to document the possibility of an orchidectomy in 30% of scrotal exploration cases. Data showed that complication incidences were only documented for 0.004% of the 721 complications mentioned in total, and a consent process was documented in the chronological notes in only 38% of cases. Seventy-seven per cent of surgical trainees surveyed across four UK deaneries stated that they would strongly support an online and mobile consenting resource detailing the recommended mentionable risks and incidences. Is it time for the traditional consenting approach to give way to an evidence-based gold standard?

Keywords: Capacity; Clinical Ethics; Education for Health Care Professionals; Legal Aspects; Surgery.