Reflections on informed consent

This is an issue I’ve been thinking about recently. I’ve had some health issues of my own which have resulted in more interactions with medical professionals than I’d like. No offence is intended to medical professionals and I’m glad they’re there, it’s just that I very much prefer my life when I don’t need to be in a hospital.

But over the last 12 months I have had quite a lot of meetings with various consultants, and I’ve had to consent to a couple of procedures including general anaesthetic or sedation. Now there are all sorts of things that I’ve weighed up in deciding whether or not to go ahead with these procedures. What are the risks of proceeding, for example, what are the risks if I don’t proceed; how long will recovery take; how long will I need to be off work (yes I know I’m a workaholic).

The answers I’ve been given have not always been particularly helpful. Indeed, at pretty much every meeting I’ve given consent and then come away with the distinct impression that the doctor wanted me to agree because that’s what they thought was the right thing to do. And that I’d agreed not because I thought it was the right thing to do, but because they were telling me I should.

For example, I went to the doctor with a concern that I was about 95% certain was nothing. I explained the issue and the doctor’s response was “well it probably is nothing, but I’d like you to get an exploratory procedure done to be sure. It’s quick and painless and will put your mind at rest”. I agreed. Said procedure turned out to be actually quite painful. I also had a bad reaction to the sedation (nobody discussed the risks of that with me before giving me it) and it delayed progress with other medical procedures due to waiting times for the results. It turned out to be nothing, as I’d originally suspected and by the time I actually had the test, my symptoms had gone away. I’d asked the doctor what I should do if the symptoms went away whilst we were waiting and their response was “well that’s up to you”.

So there I am, a reasonably intelligent person with a basic understanding of issues relating to my health, and I still don’t feel like enough time was taken to explain the situation to me. I faced a weird mix of professionals trying to make the decision for me, and of professionals trying to avoid any responsibility. It was disappointing, and frustrating, and has made me less trusting of medical professionals.

But why am I talking about this on here? I go quiet for ages and then use my platform just to complain about personal issues?

Well, no (maybe a little). Mostly I am mentioning this on here because it is relevant to working within the Mental Capacity Act 2005. When assessing capacity, professionals are expected to identify the relevant information and discuss it with P. It is for the professionals to work out what the relevant information is, and to identify the salient factors before making a determination as to capacity. But we operate in a system that seems to be actively discouraging the kind of free discussion needed for that. I’ve encountered at least half a dozen medical professionals too busy to even attempt proper risk benefit analysis with me to determine if I am giving free consent.

Are those professionals really taking the time to have a full discussion with someone who is cognitively impaired? I doubt it

I’ve even read a few capacity assessments completed by independent experts who have been paid to take the extra time to try and talk through the issues with P. And even then, there has been a lack of reasoning in parts; a certain amount of “this is my opinion and you should believe it because I’m saying it” in parts, particularly when discussing the steps taken to support P to have capacity. I see a lot of “I took all reasonable steps” without a whole lot of expansion beyond that.

Often this won’t be picked up on. In many cases these gaps will be glossed over because everyone is looking at the picture as a whole and happy to accept the conclusion in the interests of proportionality.

A lot is left unsaid because those of us ‘in the know’ are working on a set of unspoken assumptions. But I understand why it must be very frustrating to observers, and to family members who are trying to understand how and why decisions are being made about their loved ones. I imagine they leave the room feeling much like how I’ve been feeling after each of my appointments with these medical professionals.

I don’t have an answer, but it’s been rumbling around in my overactive brain for a while and I thought I might as well share…

In case it isn’t obvious from the fact I still haven’t identified the authority I used to work for, or the organisation I now work for, the views expressed on this blog are my own opinion and not the opinion of that local authority or organisation

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