Consent

consent

Recently, we had a patient under our care who spoke very little English. We could manage on very basic instructions but because the patient needed an operation, they needed to be consented for it.   Not one of us could speak anything other than fluent English, so we needed an interpreter.

I asked the ward clerk to book one in the patient’s preferred language. When interpreters are booked, they usually come the next day so I was beyond surprised when the ward clerk told me she’d arranged one for midday, little more than an hour away. I let my consultant know the good news.

Here’s where it turned sideways. He wanted me to do it. He wanted me to consent the patient for this operation. That caught me off guard. Consenting isn’t any old task. It’s a multi-layered subject that the GMC* takes very seriously because there’s so much to it. There’s so many aspects that needs to be taken into account: ethics, medical legal issues, capacity etc.

Then there’s the whole issue of F1s taking consent. It’s a grey area. We’re essentially baby doctors running around with a provisional registration. We can take consent for some procedures provided it’s something we’ve seen before. An example would be a colonoscopy (a camera that looks into your bowels). I can do that. I’ve seen several. But this operation I was being asked to consent for, I’d never seen it. I could hardly even pronounce it.

Obviously, all of this didn’t come to me at the time. I just held the phone to my ear for several seconds, trying to comprehend exactly what I was being asked to do. I started off with ‘O…..kay….’ Followed by ‘I don’t think I can’. Note the conviction in my wording. The consultant was urging me, saying I wasn’t really taking consent, I was just reading the form out to the patient and then the interpreter could sign the consent form. Still, it didn’t sit right. I was stuttering, falling over my words until eventually, I agreed.

But I was uneasy.

I walked back onto the ward heavy footed, wondering: why me? I kept going over it in my head.

Luckily, I bumped into another F1 and quickly ran over what happened. She gave me a definitive no, it wasn’t a good idea.

And really, it’s what I needed to hear. Intuitively, I knew it wasn’t a good idea. I wouldn’t be able to explain it to someone succinctly. Yes, I could read off a piece of paper, but that isn’t what consenting is about. I always find it difficult to say no, but I called the consultant back to let him know.

I managed to find someone else more versed in this procedure than me to explain it. He drew a diagram, he explained it clearly, he answered questions. Only a person with actual experience with the operation, could go into the amount of detail he did.

It made me realise how unfair it was for the consultant to put me in that position. Chances are, the operation would have gone smoothly. Yet even so, what if something bad did happen. It’s hard not to think of worse case scenario when there’s that constant reminder that you need to watch your back; we’re living in an increasingly litigious society.

Most importantly, it wasn’t fair on the patient. That patient needed to know exactly what was going to happen with their body. If they had questions, I definitely wouldn’t have been able to answer them. I knew what the aim of the procedure was, but how they were going to approach it, where they would make an incision or what exactly would happen would have been guess work. The patient deserves way more than that.

I’m really glad I made the right decision in the end. But I was so so close to making the wrong one. If I hadn’t talked it through with someone else, I genuinely think I might have done it. And it would have been a mistake. But in that moment, I felt pressure beyond belief. The consultant questioning why I couldn’t do it, telling me how busy the team were just made me feel more guilty.

It reminds me of the SJT**, the exam where you have to rank how you’d behave in different situations from the most appropriate to the least appropriate. It’s really easy to read a scenario on paper and say what you would do, but in reality, the situation can be very different. Rational thinking fails you, and your left to make quick judgement calls under a lot of pressure.

Let me know what you think. Has anyone else been in something similar? What happened? It would be good to know how I could have handled it differently.

 

*General Medical Council
**Situational Judgement Test

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