Consent: teaching how to give and take.

Editor, Michael Douglas once said “When you don't know what you're doing, it's fatal”. The process of consenting patients is a fundamental part of day to day medical life, so much so that the GMC provide comprehensive guidance on the subject1. Teaching begins at undergraduate level however training is variable throughout medical schools in the United Kingdom and regardless of how in-depth or comprehensive the ethics, law and communication components of the curriculum are, little clinically applied consent teaching takes place2. As a result when junior medical staff hit the ward they are often silently overwhelmed by the task of consenting patients when they have little experience in the proposed procedure. This may cause increased levels of stress for both the patient and junior doctor and may lead to the provision of uninformative or even incorrect answers to patient's questions3,4. The purpose of this study was to assess the effect of teaching sessions in improving the validity of consent for tonsillectomy and to develop more efficient and standardised ways to obtain consent. A retrospective analysis of 70 sets of patient notes was carried out at three ENT centres in Northern Ireland. Consent forms were scrutinised for complications outlined by ENT UK5. Several other components of the consent form including the timing of consent and the grade of those taking consent was noted. A teaching session on consent was provided at each centre and a repeat analysis on a further 70 sets of notes performed. Initial analysis showed 48%, 56% and 66% of consent forms to have been completed to the standards set out by ENT UK at the three centres respectively. Following the teaching session the three centres improved their consent taking standard by an average of 9%. There was considerable variation in the grade of doctor taking consent across the three centres with consent being taken almost exclusively by the SHO grade at one centre. Consent was obtained at the clinic 83% of the time with the remaining consent being taken on the ward prior to the procedure. Consent was not documented in any of the patient notes reviewed. Consent practices across ENT centres in Northern Ireland are variable often reflecting the constitution of staff in the department. Consent teaching sessions led to improvements across all centres and it would be reasonable to include consent teaching for common procedures as part of an induction program for junior staff. We also recommend the use of prefabricated consent stickers to improve the standardization and efficiency of consenting across all grades, we reiterate both the need for doctors to document consent in both the notes and the consent form and for consent to be taken at the clinic to allow adequate time for patients to weigh up the risks and benefits prior to the procedure. These recommendations serve not to “dumb down” or allow for outsourcing the process of consenting patients to other healthcare professionals but to create an environment where junior staff can safely be an integral part of the process despite time constraints and legal pitfalls.