Wouter Leclercq

Chapter 3 44 All doctors including senior and junior staff are legally allowed to execute SIC. Specifics of SIC are anchored in the 1995 Dutch Medical Treatment Contract Act (Wet Geneeskundige Behandelings Overeenkomst, WGBO). More recently, the Royal Dutch Medical Association (Koninklijke Nederlandse Maatschappij ter bevordering van de Geneeskunst, KNMG) published a specific guideline in a ‘Handbook of Informed Consent’. 10 In 2009 a guideline for ‘the preoperative route’ initiated by the Dutch Institute for Healthcare Improvement (Centraal Beleids Orgaan, CBO) was published with even more strict guidelines. 11 In 2010, the Dutch Society of Surgery (Nederlandse Vereniging voor Heelkunde, NVvH) and the Dutch Society of Anaesthesia (Nederlandse Vereniging voor Anesthesie, NVA) implemented this guideline as the gold standard. 12 Although written consent is strongly recommended, a signature of the patient or medical representative is not legally required. 12 Even though improvements in SIC were attained in recent years, other studies suggest that the implementation of SIC is still suboptimal in surgical practice. 1,3 Surgical staff may overestimate patient’s competence to make well informed decisions whereas patients are often unaware or misinformed on the role of SIC. 1,3,13,14 Surgeons may also underestimate the extent of information that is expected by their patients. 15 Some aspects of the information may not be understood. Moreover, patients understanding is not routinely checked. 3,5,16-20 Organisation and recording of the SIC process is often poor. 21-23 Training of residents may vary as considerable geographical differences in knowledge were found. 14,23 Whether these shortcomings are also present in the Netherlands is unknown. The aim of this study is to evaluate the reported daily practice of Dutch surgeons and residents regarding characteristics of the SIC process. We hypothesized that levels of knowledge and skills are suboptimal and may differ between Dutch surgeons and residents.