INFORMED CONSENT: ARE WE DELUDING OURSELVES? A RANDOMIZED CONTROLLED STUDY

Authors


We read this article [1] with interest. The authors deserve to be congratulated for dealing with a rather bold and thought-provoking issue. Informed consent before an intervention is a very important extension of the doctor-patient relationship. The study very clearly shows that providing the patients with additional written documents during the process of obtaining consent does not improve their understanding of the procedure or the associated risks and benefits. In most UK units, obtaining consent involves asking patients to sign a procedure-specific BAUS consent form in duplicate, with a copy going to the patient and another filed in the notes. Not only is the current practice inadequate, there is also a potential disadvantage. It is very easy for the patients to become lost in the details of the document, somewhat like ignoring the ‘small print’ while signing an insurance contract. Similarly, for the clinicians, it is easy to consider obtaining the signature on a piece of paper enumerating the most rare of complications as the end of obtaining consent, and in the process bypassing the essence of the procedure, i.e. an effective dialogue between the patient and the doctor.

The BAUS consent form, or any such document, is only a means to an end. Let us not make it the end itself. The end remains as it has always been, establishing and strengthening the doctor-patient relationship at every encounter with the patient. Securing our medicolegal interests is important, and a formal document goes a long way to that end, but above all, medicine is a humane trade. A truly ‘informed consent’ is obtained by proper eye contact, full verbal explanation, repeating oneself as often as required, and giving opportunities to ask questions and time for reflection. Clearly, the method of obtaining consent needs to continue to develop.

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