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Informed consent for elective and emergency surgery: questionnaire study

Sir, Akkad et al. raise important questions about the consent process and state that their study ‘builds on an earlier qualitative study of women’s views on consent to surgery, in which they found that patients’ accounts suggest that current procedures of obtaining consent neither adequately reflected their own views and values, nor addressed their needs in situations of increased vulnerability’. They fail to reference this work. It is significant that 25% of non-responders were of other than white-British ethnicity. A possible explanation is that many of these were unable to comprehend the questionnaire. We are not told if there was provision for translation or if inability to read and write English was an exclusion criterion. It is also pertinent that 49% of emergency patients reported that they had not read the hand-written entry in the consent form—explaining the procedure, benefits and complications. This study did not indicate whether illegibility of the consent taker’s handwriting was a significant factor in this group’s failure to read this part of the consent form. Concern has been expressed about the poor legibility of doctors’ handwriting, although it may be no worse than that of non-doctors. Meeting patient’s requirements and satisfying their expectations pose formidable challenges in virtually all spheres of health care and especially in the area of obtaining consent for surgical procedures. Some measures may go some way towards meeting these requirements. In cases of non-emergency surgery, apart from the consulting doctor giving detailed information during the consultation and also providing written information, the patient can be given the photocopy of the consent form for a particular procedure to take home and read. That provides them with the opportunity to raise questions about any areas of difficulty. Understanding can be checked during the pre-admission process and again at the time of admission. For those who tend to sign unread documents based solely on verbal communication, it is crucial that the exact contents of the consent form is read to them, opportunity given to ask questions and that this is noted in the patient’s records. How to translate patients’ requirements for satisfaction with the consent process into practice in emergencies poses a formidable challenge, but we agree it must take into account the preferences of patients themselves.