Wouter Leclercq

Summarizing discussion and conclusions 183 11 SUMMARIZING DISCUSSION This thesis focuses on several aspects of preoperative surgical informed consent (SIC) and postoperative e-health counselling. As discussed in the introduction of this thesis, an optimally informed patient will likely have more realistic expectations regarding a surgical procedure and its associated risks, as well as demonstrate a faster recovery. Well- informed patients are more satisfied, even in the event of complications or difficulties during their recovery period. Patients who are extensively counselled are known to file fewer complaints or legal claims. The concept of SIC is over a century old. In chapter 2 we reported on the historical background of SIC, the current status and future perspectives to improve this process. A surgeon must have knowledge regarding the various elements of SIC (patient competence, information, consent). In addition, a surgeon should convince a patient that not the physician but the patient should be in control. A surgeon has the obligation to professionalize and structure SIC, and he should focus on all operations, not just the most invasive ones. Lastly, he should not be afraid to use tools such as interactive software for facilitating these aims. Which specific strategies may be utilized to optimize these three different SIC elements? Regarding patient competence , clinical judgement of the care provider is just not reliable enough. Therefore, objective measures that are deemed valid in determining a patient’s competence such as the Mini-Mental State Examination, MacArthur Competence Assessment Tool, Decision Evaluation Scales (DES), or MacCaT-T are indicated. When it comes to the second element of SIC, information , it is essential for a doctor to adapt information that is derived from (inter)national guidelines to the local setting and to the personal risk profile of a patient. Patients should fully understand the plan of operation, e.g. should be able to repeat essential information when interviewed and must explain, on demand, all relevant risks and alternative treatment options. The third element of SIC, consent, requires a succinct but complete registration. The SIC process should be recorded in detail using an adequate SIC form. This form has to be completed correctly and retrievably stored in a specific part of the EPD or medical record. It must be appreciated that all of these three items of the SIC process are dynamic. Therefore, regular updates must be critically evaluated and possibly incorporated in future versions of SIC. In chapter 3 and 4, questionnaire studies supported by the Dutch Society of Surgery and the Orthopaedic and Plastic Surgical Societies evaluated the knowledge base, skillset and daily practice of general, orthopaedic and plastic surgeons regarding SIC. Chapter 3 focused on Dutch general surgeons and trainees. It appeared that the quality of the current