Informed Consent - it’s a process, not a form
As a medic you know that before you go ahead with any treatment with any patient it’s absolutely vital you gain informed consent.
But what actually is informed consent? Are you consistently obtaining it? And are you documenting it appropriately?
Here we cover the fundamentals of informed consent and how your documentation can either protect you, or make you vulnerable, in the case of a claim.
What is Informed Consent?
Informed consent is the exchange of information that enables patients to make a decision, after being told all of the relevant information and facts about that treatment.
The key word is ‘exchange’. Informed consent is a two-way communication process. A dialogue.
You are not gaining informed consent if you issue your patient a written description of a treatment, including a list of the benefits and risks and they sign it remotely, without any discussion. You have not adequately consented them and this approach is unlikely to protect you in the case of a claim.
The GMC sets out 7 key principles for the consent process. While it's directed at doctors, it’s relevant for all aesthetic professionals involved in administering medical procedures:
All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.
Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.
Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. A patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements.
The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those who are close to them or advocating for them.
Patients whose right to consent is affected by law should be supported to be involved in the decision-making process, and to exercise choice if possible.
Informed consent ensures the patient has the opportunity to be informed of, and had time to consider, all the relevant information that could influence their decision regarding a treatment.
The end result is that you both have a shared understanding of the expectations and limitations of the treatment and that this is documented systematically, securely and accurately
What’s the point?
It goes far beyond just ‘something you have to do’.
Ethically, legally and morally it’s the right thing to do and it’s a significant aspect that distinguishes you as a healthcare professional offering medical treatments from a lay practitioner offering beauty treatments.
Informed consent is crucial to find out what matters to your patient. It should be baked in to your consultation. It’s about learning about them, their concerns, their fears. Gaining an understanding of their lifestyle and the implications these factors on the treatments you recommend to them.
It’s also about discussing the benefits and risks openly and transparently, to enable patients to make the right decision after getting any questions answered clearly and fully.
It’s not just a signed consent form
A signed consent form is just one element of the documentation process. It is not the process, nor is it the only piece of documentation you need.
Simply asking a patient to sign a consent form, particularly ahead of the appointment, is not sufficient to a) properly educate the patient of the benefits, risks and alternatives or b) protect you in the case of a claim.
Consent forms form part of the package of information you share with your patients, from the point of their first enquiry, through their consultation, to the post-treatment advice.
Your consent process should enable you to:
share information in a way that the patient can understand, in clear, non-medical language. Use diagrams and visual aids where necessary.
share information in a way that the patient has time to read, digest, understand and retain it.
not shy away from sharing potentially distressing or off-putting information about treatments. You have to share the good, the bad and the ugly.
give the patient time to reflect, before and after they make a decision, especially if the information is complex or what you are proposing involves significant risks.
gain written consent from your patient.
evidence that you have done each of these things thoroughly, accurately and contemporaneously.
You Can Say No.
Sometimes, during the process of obtaining informed consent information arises that requires you to refuse treatment. Some practitioners feel awkward doing this, and end up in difficult situations with their patients.
If in doubt DON’T TREAT.
If you’re not 100% certain that a patient is a good candidate for a treatment, that they FULLY understand the benefits, risks and limitations & they are likely to adhere to pre- and post-treatment guidance…DON’T TREAT!
It’s one thing for a patient to make poor treatment choices, it’s another for you, as a registered healthcare professional, to facilitate those poor choices!
Hamilton Fraser, the largest insurance provider for medically qualified practitioners, says:
“Informed consent requires the aesthetic practitioner to discuss with the patient the purpose, risks and benefits of the proposed treatment and to communicate and document this process in detail. The practitioner doesn’t have to approve of the patient’s choice – a patient is free to make an ill-advised choice – although the practitioner may decide it is safer to say ‘no’ if they feel the patient is not suited to the treatment. The critical factor when it comes to consenting is that the patient’s consent must be informed by having all the risks and benefits of their chosen option explained clearly to them.”
The Bottom Line
Ultimately, informed consent is a responsibility you have to your patients to meet keep them safe and cared for.
The practical element of gaining consent and documenting that properly not only keeps your patients safe, but also reduces the risk of a claim resulting from treatments you administer.
Really, there are only three key principles you need to remember:
Develop a robust and repeatable informed consent process
Apply it consistently to EVERY patient you treat
Systematically, securely and accurately document this process
Informed consent is down to YOU. You lead the discussion. You tailor the dialogue. You document the process. You’re the gatekeeper of aesthetic treatments. It is not a case of a patient requesting a treatment, signing a consent form and you delivering that treatment. It’s your responsibility - your name, reputation and potentially your statutory registration on the hook. Don’t cut corners.
Further resources:
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent
https://hamiltonfraser.co.uk/knowledge/best-practice-for-patient-consent/
https://www.jccp.org.uk/ckfinder/userfiles/files/JCCP%26CPSA%20Code%20of%20Practice_v2.pdf
https://hamiltonfraser.co.uk/cms/wp-content/uploads/2018/08/7-Consenting-principles-and-pitfalls.pdf