The mole remains the same

Elwyn’s comment is interesting as an appeal. However, one wonders whether this ideal is a factual elution or a wish list.¹ I would like references for his statement that “Consent is often completed a few hours before the intended procedure.” Does he mean the reaffirmation or the primary consent taking process? In hospital, the latter may be performed at preoperative assessment, several weeks before the procedure.

Further, Elwyn’s idea of “a series of clinicians working to a common goal” suggests more cooks to spoil the broth. Patient information sheets—with a copy retained on file to ensure everyone knows the information imparted—are not mentioned.

Finally, there remains the illusion that consent taking is peculiar to hospital practice and involves a written form. How often is a consent form used for removal of tissue or intimate examination in primary care, and how many dentists require a consent form to be completed to Department of Health standards for a root canal procedure? All of the above carry a risk.

Yet we still think that a consent form is essential—it is not, although documentation of consent is—and a right of passage to an operating theatre. Removal of a mole will involve minimal consent in primary care compared with a hospital setting. The mole is the same, it is the setting that differs. A bunion operation that carries little risk will have a consent form for the procedure and general anaesthetic, yet a lumbar puncture or chest drain insertion that has much higher and graver risks will have no consent form completed. Why? Is a consent form really a right of passage to have a general anaesthetic and to have the procedure in an operating theatre?