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I don’t want the gory details doc!

Often when it comes to discussing surgical procedures, some patients will say, “I don’t want to know the details just get on with it”. Problem is, in modern day medicine, the law on consent has shifted from “Doctor knows best” to “shared decision and responsibility”. This is certainly a good thing as it means that the the patient receives a much more detailed explanation of the planned procedure and risks associated with the procedure. Written advice sheets are now more or less mandatory, some with diagrams demonstrating the surgery.

Back in the day we used the Bolam test to measure consent to treatment. This essentially meant the the procedure carried out was in line with what a “body of medical opinion” would do. In other words, do your medical mates accept it was the  right procedure.

This was further modified by Bolitho in that the Judgment stated that treatment must also be “reasonable” and “logical”. The real sea change came in 2015 in the case of Montgomery Vs Lanarkshire health board. In this case the Judge ruled that the patient must be given enough information on which to make and informed decision. The key words here are informed and information! In this case the Judge ruled that the patient if provided with enough information is capable of weighing up the pros and cons and can take responsibility for their own decisions.

This means in practice that the surgeon will and must explain the  procedure and risks in such a way that they can be understood, and  also weigh the % risk to the individual patient. An example would be:- The risk of stiffness in a joint post surgery may be 10%. If the patient was sedentary and limited in daily activity, this risk might not be an issue, however if the patient was a professional athlete, the risk may be unacceptable and the may decline surgery. The risk to both patients although still 10% is weighed very differently.

Make sure when you attend for consultation that the risks are fully explained to you!


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