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Patient participation in decision-making and consent to treatment: the case of general surgery.

Recent political initiatives have sought to encourage patients to seek increased participation in decision-making on treatments. In NHS surgical care, the consent process begins most commonly with an outpatients consultation within which the implicit rules of communication and participation are conveyed to patients by the setting, and the routines of the service providers. The signing of the consent form just prior to surgery while on the ward tends to be a re-affirmation of the strengths and weaknesses of the relationship established there and the discourse on which it is based. 
 
 
 
The reflections of surgical patients and staff reported here suggest that politico-legalistic measures to encourage and increase patient participation in surgical decision-making will continue to be frustrated. This may occur not simply because of a natural desire on the part of surgeons to reaffirm established professional rights to control the form and content of consultations, but because more demanding patients will disrupt the methods by which surgeons and other service providers have been able to fulfil the demands for patient throughput which a pressured health care system places on them.