Te patient subsequently suffered a severe post-operative infection that took many painful months to clear with antibiotics. A claim of negligence based on the fact that the patient had not been informed of the infection risk was lodged and eventually settled by MDDUS on behalf of the surgeon.
Need
know M
to
OST people know the story. In 1998, an article was published in Te Lancet by Dr Andrew Wakefield and 12 other authors suggesting a link between the MMR vaccine, autism and bowel disease, based on a study of only 12 children. In a subsequent press conference Wakefield called for the suspension of the vaccine until further research could establish its safety.
Te resulting scare led to a drop in MMR vaccination rates in the UK from 92 per cent to below 80 per cent and a consequent resurgence in measles that is still being felt today, with a recent outbreak bringing a ten-fold increase in the disease in England and Wales in the first four months of 2011. Even now, despite the research being discredited and Wakefield himself struck off the GMC register, MMR inoculation rates still stand below 90 per cent. Te case well
16
Informed consent is a core principle of medical and dental care but few patients want a lecture in statistics
illustrates how the notion of risk in medical procedures is not just a numbers game – it’s as much about attitudes and perception. Just how patients perceive risk is a crucial factor in the regulatory duty of healthcare professionals to engage in shared decision- making with patients and obtain informed consent. MDDUS case files contain numerous examples of doctors and dentists failing in this regard and facing civil court judgements and disciplinary action by the GMC and GDC.
One typical case dealt with a 71-year-old woman diagnosed with a L4/L5 disc protrusion compressing the L5 nerve root, causing her severe hip pain. Te surgeon recommended surgical decompression and briefed the patient on the procedure but did not bother to discuss the slight risk of deep post-operative infection (spondylo- discitis/osteomyelitis).
Shared decision-making Consent is a bedrock principle for healthcare professionals and both the GMC and GDC have separate guidance documents devoted to the topic. In Consent: patients and doctors making decisions together, the GMC states: “You must work in partnership with your patients. You should discuss with them their condition and treatment options in a way they can understand, and respect their right to make decisions about their care.” But this is sometimes easier said than done when you consider the wide range of patients that doctors interact with and their varying ability to understand sometimes complex medical procedures, not to mention the reluctance of some patients to even engage in the decision-making process. Te GMC advises that doctors should “not make assumptions about what information a patient might want or need, the clinical or other factors a patient might consider significant and the patient's level of knowledge or understanding of what is proposed”.
Baseline consent calls for healthcare professionals to provide patients details of any uncertainties over diagnosis and prognosis and options for treating the condition, including ‘not to treat’. Te purpose of any proposed investigation or treatment and what it will involve should be explained along with potential benefits, risks and burdens, and likelihood of success. In private care, dentists and doctors must also make clear to the patient the nature of the contract for care including all charges and the probable costs of further treatment.
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