Following several recent verdicts by the Singapore Medical Council, doctors are experiencing many uncertainties on what qualifies as taking consent (MOH conducting thorough review of informed consent, March 3).
First, who should take consent, or be allowed to do so, when patients are managed by a team?
Should the senior doctors of the team be responsible? Or can a junior member like a resident or an intern be allowed to take consent for a complex operation?
Second, what types of procedures are exempted from official consent?
Currently, procedures that have a surgical code, like injection into a joint or a gastroscopy, require formal written consent. But what about blood-taking, setting of an intravenous plug, or insertion of a urinary catheter or nasogastric tube? Or a physical examination like pelvic, rectal or breast examination? Is officially signed consent needed, or is verbal consent sufficient?
If written consent is needed for every single step of a patient's medical care, it will be impossible for patients to receive prompt and appropriate care.
Third, how much documentation is required for the taking of informed consent for a complex surgery?
When I explain liver transplantation to a patient with liver failure, the consultation can take several sessions, with each session lasting up to 30 minutes. How much of this is the consenting process, and how much of it ought to be documented?
In addition, will the committee provide standard consent forms, which are downloadable from a Ministry of Health (MOH) website, for, say, the 1000 most commonly performed operations and procedures in daily clinical practice?
Or will the committee merely provide guidelines and principles of the consenting process?
Lastly, who will be in the newly formed consenting committee?
Will the MOH consider a bottom-up approach where doctors who face patients daily, like residents and family physicians, are invited to the panel?
Or will the committee involve only heads of departments and senior health administrators?
A proper consenting process protects patients by ensuring all important aspects of a particular kind of medical care are explained. But it must also be balanced with its practicality and the cost involved.
This is no easy task.
MOH must be applauded in taking the lead to ease uncertainties on the ground and provide a balanced consenting process.
Desmond Wai (Dr)