Wouter Leclercq

Insight in information provision prior to obtaining surgical informed consent by audiotaping outpatient consultations 101 6 DISCUSSION This study aimed to provide insight into the current practice of SIC in the Netherlands. The results show that, despite more than half of total consultation time being spent on SIC, several information categories were hardly mentioned. In many cases, the written documentation of the SIC process did not match the actual information discussed with the patient. This is one of few studies that has analyzed what SIC information is actually discussed during patient consultations. Most of the previous studies that aimed to analyze the current practice of SIC either endeavored to describe the patient’s understanding of discussed information or the surgeon’s knowledge of SIC. 8,12,13 From the few that studied the actual patient-informing process 10,14,15 , only Knops et al. focused on the surgical part of informed consent. As with our study, Knobs et al. used audiotapes and a checklist to analyze consultations. Our main findings are in line with their results, as they show a considerable variation concerning the information received by patients, as well as the neglect of certain information categories (treatment purpose, treatment risks, and alternative treatments). The combined results of these studies suggest that, in current practice, no unambiguous way of informing exists and certain information is less well covered. The checklist items are unproven when it comes to their value for the patient’s decision- making process concerning their consent to treatment. This is because we did not ask the patients about their opinion concerning the relevance of the items. Therefore, the relevance of the relatively less discussed categories is unclear. However, other studies suggest that, in general, patients seem to value extensive information on treatment risks and the postoperative period. 9,16 Moreover, patients from a former study liked to know who would be their operating surgeon, and they have opined to be informed about the level of resident participation during surgery. This kind of information could have changed their decision for consent. 9,17 This suggests that, despite the fact that these information categories are relatively less well covered, they might still be relevant to the patient’s consent. In the case of a malpractice claim or lawsuit, sufficient documentation of the discussed information aids the doctor in proving that certain information was given before the start of treatment. 18,19 Not surprisingly, adequate documentation has been associated with a decreased indemnity risk. 20 It is particularly remarkable that, since this documentation can be used as evidence in court, a discrepancy between documented and actually discussed information was found. This discrepancy was found in all of the three hospitals, but