Letter: Consultants do inform patients

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Sir: As a near contemporary of Dr Phil Hammond (article, 3 May), I suspect that his illustrations of the problems of informed consent for medical procedures are derived from memories of his time as a junior house surgeon. It used to be standard practice to delegate pre-operative counselling to the most inexperienced member of the team, often with much bluffing.

Much has changed since then. Patient expectations are now much higher, sometimes unrealistically so. Publicity over medical mishaps is important in a free society, but often contributes extra worry to patients, even though the scale of media interest reflects how rarely such mishaps occur. Rapid technological advances now bring very complex procedures into routine clinical practice, placing a greater burden of explanation on medical staff.

There has been a move towards a consultant-based, rather than consultant- led service, and "informing" and "consenting" now rest rightly with senior staff. For elective surgery, signature on an NHS standard form of consent does not constitute informed consent, and is a simply a record of agreement to proceed. Each patient must be informed to their own level of satisfaction. This process should begin with the patient's GP and the pre-operative visit to the consultant's clinic. In my own hospital, the form is usually signed in a pre-admission clinic a week before the operation, which provides a further opportunity for patients to meet and question both the doctors and nurses who will be providing most of the patient's care.

As regards the availability of audit results, Dr Phil will be aware that surgeons were the first group of clinicians to voluntarily audit their practice, and it is now compulsory across hospital specialties. An advantage of the current NHS referral system is that even if surgeons do not find out "how their hernias do" - as we can no longer afford follow-up out- patient appointments following simple procedures - GPs do, and rapidly develop a sense of who performs well or otherwise. Thus consultants do receive regular feedback - either directly, or through lower referral rates. Audit results are increasingly available in medical literature and on institutional Internet Web sites such as our own.

One thing has not changed since Dr Phil's last direct contact with the surgical world. Most NHS consultant surgeons across the nation are still allocated a measly 10 minutes for their new patient consultations. Hopefully this problem has already been earmarked for urgent reform.

MIKE LARVIN

Consultant Surgeon and Hunterian Professor of Surgery

Leeds Institute for Minimally Invasive Therapy

Leeds General Infirmary

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