Wouter Leclercq

A review of surgical informed consent: Past, present, and future. A quest to help patients make better decisions 31 2 FUTURE IMPROVEMENTS OF SURGICAL INFORMED CONSENT Substantial weaknesses and omissions of SIC are evident and the current elements of the SIC process are largely neglected in daily practice. 19,20,27-35,37-39,41,44,45,47,48 Preconditions are ignored, information is incomplete, and the consent itself is not an accurate reflection of the patient’s authorization. SIC apparently is not a popular part of the doctor–patient relationship, and presumably both parties are guilty. In the media surgeons are blamed for making mistakes and people are encouraged to ‘‘sue for every fault their surgeons make,’’ leading to an increase in medicolegal claims. 35 However, it should be realized that most legal cases are not due to failures in treatment but due to failure in communication. 11,35 Discrepancies between expected and achieved results (55%) and faulty information (30%) are the main reasons for patients to file claims. In contrast to what one would expect, most complaints are generated after minor elective operations (70%). 52 Articles analyzing the quality of the SIC forms and their performances in court were not identified in the present overview. Circumstantial evidence, however, supports the view that ample opportunities are available to improve not only these forms but the whole SIC process. An IC form is inadequate if it deals only with the IC form itself while omitting the incorporation of the information process or the quality of the total process. Several cases based on faulty forms resulted in successful claims: no documented alternatives, risks, or IC form at all. 53 Hence, a nonstandardized way of informing a patient of the risks of complications inherently results in a vulnerable position for the surgeon. 25 Both surgeons and their patients must realize that an improved and standardized IC process leads to more realistic expectations. Better-informed patients are more satisfied, have a higher commitment to their treatment, and demonstrate less tendency toward filing legal claims. 53 Both groups obviously have a lot to gain from an optimized SIC process. Strengthening the surgeon’s education on SIC might look like an easy way to optimize the SIC process. However, training doctors, or specialised nurses, aimed at improving their skills in the SIC process is not very successful and this approach is very time consuming. 38,54-56 A computer may aid the doctor help his patient receive high-quality SIC for elective procedures. It should be realized that computer programs do not undermine the doctor– patient relationship but are potentially valuable. 40,42 The SIC should therefore ideally be performed using an integrated interactive computer program. 40,42,56 As most surgeons prefer to spend their time on surgery itself, they must consider introducing computer technology as an aid in the SIC process in daily surgical practice.