CLINICAL GOVERNANCE-PART II

In our last blog we talked about clinical governance. Today, in this blog we will talk about CONSENT.

Consent is a process during which the professional provides adequate and accurate information concerning a procedure to a patient that allows them to reach a considered decision.

INFORMED CONSENT:

• It is required for all operative procedures.
• It involves informing the patient about the diagnosis, degree of certainty regarding the diagnosis, the surgery that would be recommended in that case and possible alternatives along with their expected outcomes, risks, and benefits.
• The surgeon may make use of written material (self-explanatory patient leaflets), visual aids (models), websites, etc. for explaining the procedure to the patients.
• The woman must also be made aware of the type of anaesthesia planned and be provided with an opportunity to discuss it in detail with the anaesthetist before the surgery.
• Informed consent should include: nature of the procedure; rationale of doing the procedure; advantages and disadvantages of doing the procedure; and availability of alternatives.

ELEMENTS OF INFORMED CONSENT

• Disclosure of information
• Comprehension by the patient
• Voluntary transaction
• Validation

EXCEPTIONS TO THE INFORMED CONSENT

• Emergency situations
• Intentional relinquishing by the patient
• Mental illness
• Therapeutic privilege
• TYPES OF CONSENT
• Implied Consent
• Verbal Consent
• Written Consent

COMPONENTS OF CONSENT

• Capacity
• Information
• Communication 

CONSENT FOR GYNAECOLOGICAL PROCEDURES

Various gynaecological procedures that require consent includes:

• Pelvic examination
• Breast examination
• Unexpected pathology
• Unexpected pregnancy
• Infertility
• Sterilisation
• Termination of pregnancy

CONSENT FOR OBSTETRIC PROCEDURES

• Consent by women in pain and in labour
• Assisted vaginal deliveries, emergency cesarean section and perineal repair
• Ultrasound examination in pregnancy

CONSENT TO SCREENING TESTS IN OBSTETRICS AND GYNAECOLOGY

Screening (which may involve testing) healthy or asymptomatic people to detect genetic predispositions or early signs of enervative or life-threatening circumstances can be a key tool in providing effective care.

OBTAINING LEGAL ADVICE

Legal advice is recommended in cases where the patient is mentally unstable. This comes under the Mental Capacity Act. 

Management of the patient using the Mental Capacity Act 2005: It allows the appointment of an independent mental capacity advocate to speak for a person who lacks capacity and does not have anyone (a family member or friend) to assist her in consideration of her choice of treatment, if time allows.

CONSENT FOR MULTIMEDIA IMAGES & TRAINING 

• Multimedia images from laparoscopic findings, ultrasound pictures and X-rays do not require additional consent but images which may be used for education or teaching, require written consent.
• During various clinical examinations, explicit consent of women is of utmost importance for the presence of students.
• No particular consent is required for tissue removal for histological purposes, but she should at least be made aware that tissues and samples might be removed at the time of procedure for which consent is being acquired. 

Jaypee Brothers Medical Publishers organises a course regarding MRCOG exam. The course includes webinars on various significant topics. The upcoming webinar is on the “Clinical Governance” that will be organized on March 30, 2019. 

For further information regarding the course, please visit our website www.crackingmrcog.com

For More Information:

Email: crackingmrcog@jaypeebrothers.com

Whatsapp: +91-9873886225

Website: www.crackingmrcog.com

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