Patient Informed Consent Compliance 5 Day Series: Day 4

12 January, 2018

CONSENT NOT REQUIRED
  1. Medico-legal cases brought by Police
  2. In case of medical examination and issue of Certificate for Insurance Policies
  3. A person suffering from disease under “notified” category (notify the authorities only)
  4. Prisoners
  5. Examination under Court Order
  6. Request by a Police Officer under CrPC
COMMON PITFALLS OF CONSENT
  1. Records The most common pitfall is the failure to have an adequate record of the consent process and as a consequence, incomplete details of what were discussed with the patient. The best and most contemporaneous record available is the patient’s clinical record card. It should contain, amongst other information, comprehensive records of the discussions between a patient and a dentist. This can be supplemented by patient information literature, written treatment plans, quotations and consent forms as appropriate.
  2. Poor communication skills Perhaps the greatest reason for an inadequate consent process is a lack of communication and interpersonal skills in either the patient or the dentist. The barriers to good communication are: poor listening skills, inappropriate assumptions about the patient, inappropriate language and prejudice. Poor communication increases the threat of complaints and litigation even when the clinician has not been negligent.
  3. A failure to involve the patient Consent is not about giving information to the patient. It is about involving the patient in a mutual discussion so that the patient can make his/her own decision. Patients are less likely to criticise their own decisions than those made by others.
  4. A failure to provide alternatives One of the key aspects of the consent process is to make the patients aware of the alternatives even if the treatments in question are not provided.
CAN CONSENT FOR DIAGNOSIS BE EXTENDED FOR PERFORMING ADDITIONAL OR SURGICAL PROCEDURE?

As per the judgment of Supreme Court, no additional procedure can be performed in violation to what had been explained to the patient, even if the procedure is time, money and pain saving. Any additional act amounts to assault and deficiency in services. However, exception for life threatening situation only. The court allows additional surgery in life threatening situations or to preserve health of the patient, it leaves several unclear grounds for that. Hence in our routine practice we shall exercise our own wisdom in understanding legal responsibilities by over protection for the safe practice.

ROLE OF HOSPITAL

The question arises that does the hospital have a responsibility to ensure that the patient received adequate disclosure. Under the theory of “Respondent Superior”, an employer (hospital) could be held jointly liable with an employee (doctor) whose failure to obtain informed consent could be shown to have caused injury and damage to a patient. A hospital policy must govern the procedure by which consents are obtained. A patient can withdraw consent after signing a consent form. Though this is the rule, but there are practical limitations. In such cases, if patient is admitted in a hospital, it is the obligation of the hospital to make sure that no member of the hospital staff performs the refused procedure.

Read Day 3 Here

Read Day 2 Here

Read Day 1 Here