Consent, communication, surgery, body donation, and the Human Tissue Act.

Consent is always a topical issue. The General Medical Council (GMC) and the Medical Defence associations are always keen to see that patients are treated carefully and in line with good medical practice. Communication is an essential part of consent and if doctor-patient communication is good and is well documented in the notes, problems do not usually occur. Knowing what to communicate, however, is not always clear. This issue of the journal contains some papers that will help answer this question. For those women having gynaecological surgery including hysterectomy and operations for incontinence1, patients often ask how soon they can drive after surgery. The answer clearly varies depending on the gynaecologist performing the surgery2. National guidelines are needed for consistency.

Complications may occur after surgery and can often be predicted. A staggering nine percent of patients experience chronic pain after hernia surgery3. Some have mild pain, but in others, it may be severe and it impacts heavily on the quality of life. The majority can be managed well but good communication of the risks and the impact on the patient of potential complications and their potential treatments, done well before surgery, is paramount.

Even after death, the question of consent arises with communication to other family members about the wishes of the deceased4. The new Human Tissue Act defines what is appropriate consent as well as who may give it5. The act makes it unlawful to use bodies or human material for purposes other than that for which the patient gave consent (figure). Hopefully our doctors of the future will have the communication skills they need and a sound knowledge base, to help them inform patients fully under the new curriculum introduced into medical schools and monitored by the GMC.

fig

Rembrandt – ‘Anatomy Lesson of Dr. Nicolaas Tulp’ © Mauritshuis Museum, The Netherlands