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Royal College of Surgeons advises doctors to let patients decide on treatment options



The Royal College of Surgeons has advised doctors to let patients choose whether or not to undergo medical treatments in new consent guidance.

According to the guidance, doctors must now outline every risk of the procedure that may be significant to the patient along with other treatment options.

The guidance adds that in cases where patients ’choose to refuse treatment and this path is potentially dangerous or fatal, surgeons must respect the patient’s decision.’

Intending to replace the ’paternalistic’ approach to consent with a ’patient-centred perspective’ the RCS guidelines says surgeons are ‘no longer the sole arbiter of determining what risks are material to their patients’.

The RCS warns that if these changes to how doctors obtain consent are not made, NHS trusts could face increasing medical negligence claims.

According to the NHS Litigation Authority, which handles medical negligence claims on behalf of hospitals, trusts in England paid out more than £1.4bn in during 2015/2016.

This warning comes following a judgment given last year in the Supreme Court case of Nadine Montgomery, who son has cerebral palsy.

Ms Montgomery, who is small and a type 1 diabetic, was awarded £5.25m after doctors failed to tell her the risks of her condition and offer her a caesarean section.

The judges in the case said doctors must tell patients the ‘material risks’ that will matter to them.

The new guidelines clarify that doctors must assess a ‘material risk’ as one that ‘a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would likely attach significance to it.’

Mr Leslie Hamilton, a Royal College of Surgeons council member, said the RCS is ‘very concerned that doctors and hospitals haven’t fully appreciated’ how the judgment changed the understanding of patient consent.

He said: ‘Hospitals and medical staff are leaving themselves very vulnerable to expensive litigation and increased pay-outs by being slow to change the way the consent process happens.

‘We cannot underestimate the psychological impact facing litigation can also have on doctors. It can do serious damage to their confidence in practice and their reputation. Doctors must protect themselves and their patients by ensuring the consent process is carried out properly.’

Dr Keith Grimes, a GP in East Sussex, said on Twitter that shared decision making is something that “GPs have been doing for decades, and I learned about 16 [years ago].’

Dr Martin Brunet, a GP in Guildford, said he agrees with the guidelines but hopes ‘doctors don’t now abandon patients in making decisions’.

The BMA also added that implementing the new guidelines will be “difficult”.

Dr Mark Porter, BMA chair of council, said: ‘Doctors must have the time to fully explain and outline the risks involved in any procedure to their patients before it takes place. In today’s NHS it is becoming increasingly difficult as we face rising demand and staff shortages.’