Risk assessment and consent

Valid consent to examination and treatment is absolutely central in all forms of healthcare, from providing personal care to undertaking major surgery. The fundamentals of best practice in consent are covered in literature published by the Department of Health (DoH) and the General Medical Council (GMC) has recently updated its guidance on consent for doctors. Both sets of guidance emphasise that seeking consent is a process and should reflect a partnership between healthcare professional and patient. Valid consent requires the fulfilment of three criteria; the patient must have capacity, the patient must have sufficient information to make the decision and the decision must be voluntary. To ensure that the decision to proceed with an investigation or intervention is informed the potential risks must be disclosed in a manner which the patient can understand. Risks may be general and specific, and efforts have focused on establishing systems for assessing and quantifying risks in certain age groups, conditions and procedures. There are many examples of scoring systems which have been validated and introduced into routine practice. Whilst these can separate patients in to broad risk categories for an intervention they need to be brought into context and the individual seeking consent must ensure that the risks quoted reflect the circumstances of the patient and the intended procedure. Excellent communication skills are required when seeking consent and the terminology used to describe the risks is also important. All staff seeking consent should undergo training in both basic principles and procedure specific details. Finally the importance of accurate and contemporaneous documentation cannot be over emphasised.