Wouter Leclercq

A survey of the current practice of the informed consent process in general surgery in the Netherlands 51 3 DISCUSSION The aim of this study was to investigate the daily practice of the SIC process by general surgeons and residents in the Netherlands. It was assumed that level of knowledge and skills were suboptimal. Results of the present study indeed confirmed this hypothesis. Interestingly, considerable differences between knowledge levels of surgeons and residents regarding various elements of SIC were identified. It may be assumed that lack of knowledge, training and structure in the SIC process may result in a suboptimal implementation in daily practice. Conversely, an optimized SIC process may enhance patient compliance, safety, satisfaction and trust, leading to an improved physician-patient relationship. The present study is the first of its kind in the Netherlands. However, a lack of knowledge on most aspects of SIC is consistently found in various other studies investigating surgical staffs in Europe, USA and New Zealand. 1,5,14,25-27 Residents performed worse compared to surgeons in Ireland, Germany, UK and USA. 23-25,28 They do not feel confident due to a lack of training 5,13,23,24,26,29 , and up to 60% of residents in the USA claimed that they never received any feedback on these issues during their residency. 29,30 In recent years, informed consent was topic of debate in the USA and the UK and improvements in care followed. However, this debate was not so intense in the Netherlands. Dutch surgeons judge the process of SIC important but they are faced with uncertainties in daily practice. Which aspects of SIC are obligatory and which are accessory? Residents were familiar with some elements of SIC but evidently lacked practical knowledge and practice on other aspects of SIC. The recently updated curriculum for Dutch surgical residents referred to SIC only twice and just in general terms. 31 Moreover, training for surgical residents is only starting to be implemented. It may well be that surgeons still improve their knowledge the hard way, that is through complaints and legal actions. Future surgical residents require optimized training in SIC using specific courses supported by supervision in daily practice. An option would be to incorporate an educational SIC programme in the early phase (year 1-2) of the surgical residency. Structuring a SIC process will improve its quality, completeness and legal solidity. Moreover, it will improve patient satisfaction, safety and prevent high impact malpractice claims. 1,32-35 In recent years, preoperative safety programs (SURPASS) have structured and improved patient safety significant, but there was little interest in the aspects of SIC. 33 A standard SIC form was introduced and successfully implemented in daily practice in various countries including Australia and the UK. 23 According to the present study, the SIC process in the Netherlands is highly dependent on local and personal circumstances. Therefore this process requires standardization and implementation in preoperative safety programs. A substantial number of respondents would like to receive specific forms that are designed to guide doctors and patients through the steps of the SIC process. 23