For Family Medicine Professional Choices Situation Judgment test (FMProC), when the patient is competent, seeking informed consent is a relatively straightforward process, as follows:
Doctor assessing: The patient and the doctor discuss the presenting complaint. During the consultation, the doctor gauges the level of understanding of the patient, takes account of their views and values, and presents a range of possible management options.
Doctor discussing: The doctor describes the available options, including:
- Diagnosis and prognosis, including degree of certainty and further investigations required
- Different management options available to the patient, including the outcome of receiving no treatment. It is likely that the doctor will recommend a preferred course of action, but he should in no circumstances coerce the patient
- Details of any necessary investigations/treatments and/or procedures, including their purpose, their nature and which professionals will be involved
- Details of the risks, benefits, side-effects and likelihood of success. The doctor should inform the patient of any serious possible risks (e.g. death, paralysis, etc.) even if the likelihood of occurrence is very small. He should also inform the patient about less serious side-effects or complications if they occur frequently
- Whether the procedure or treatment is part of a research program or innovative treatment, as well as their right to refuse to participate in research or teaching projects
- their right to a second opinion
- Any treatment that you or your Trust cannot provide, but which may be of greater benefit to the patient. This may include procedures for which no one has been trained in your hospital, or treatments not provided by your Trust on grounds of cost, but which may be provided elsewhere.
The information should be provided using terms that the patient can understand and the doctor should check the understanding of the patient, answering the patient’s questions as appropriate. When asked questions, the doctor should endeavor to respond in the most informative manner, avoiding coercion. If necessary, the doctor should use all necessary means of communication, including visual aids, leaflets and models.
Patient considering: the patient weighs up the benefits and risks and determines whether to accept or refuse the proposed options. If the patient refuses, then the doctor should explore their reasons and continue the discussion as long as the patient wants to. There may be concerns that were not identified or addressed previously. The doctor should inform the patient that they have the right to a second option and the opportunity to change their mind later on, if they so wish.
There are circumstances when further procedures may be necessary during the primary planned procedure (e.g. blood transfusion, or doing a different surgical procedure). You need to explain these anticipated risks to the patient clearly and obtain consent for these potential procedures (otherwise you will need to wake the patient up to seek further consent).