[Informed consent in surgery. Distance between theory and practice].

Abstract

Information is an important aspect of the doctor–patient relationship and an important part of medical care. It would seem logical to expect that, together with the development of science and technology in medicine, patient information would also have improved. However, the current situation, as manifested by patients themselves, proves otherwise. Nowadays, patients tend to demand more information from their doctors. It seems that the so-called principle of autonomy is gaining on the paternalistic attitude. Patient participation in decision-making that affects their health status has become critical and is the axis of the whole medical process.As stated by Broggi, ‘‘It’s about discovering what the patient’s expectations and preferences are and adapting to them as closely as possible, while putting our knowledge and possibilities at their disposal.’’ We might ask ourselves whether the so-called Informed Consent (IC) process has met this goal. IC should not be limited to merely signing a paper authorizing us to perform the proposed procedure. It requires certain conditions. Its prerequisites are patient competence and willingness, sharing information and recommending a treatment plan that the patient understands and, finally, is willing to sign. For proper implementation of IC, a calming approach is necessary. Bias should be avoided when explaining the information and appropriate documents should be designed. It is necessary to allot enough time for verbal communication as well as for the patient to read the document and make the decision without feeling pressured. We often see factors suggesting that we still have much to improve in the process of implementing IC. These include the following: Limited verbal information – Some physicians believe that since the information is provided in the document, it is not necessary to verbally inform patients about the details of the procedure. Improper design or content–Deficiencies are frequently seen in some documents. They may not explain alternatives to the procedures, personal risks or highly likely consequences of the procedure. The frequency of risks and adverse effects may not be sufficiently defined, while only providing percentages from the literature and not the department itself. Likewise, there is usually no statement guaranteeing continued care even if the patient does not choose to consent to the procedure. Sometimes, IC documents are written in such a way that they give the impression that their only objective is to establish legal safeguards. We may also find that certain documents intend for patients to accept everything that could happen, while assuming that any adverse effects would be due to mere chance. Another situation that has been occurring is the use of documents requiring the patient to agree to the procedure and to sign that he/she has been completely informed, but with no information given in written form. In the same IC document, it is also common to request consent to film the procedure or to store tissue samples in biobanks, rather than using separate consent documents for these situations. Legibility and comprehensibility–The use of excessive medical jargon, long sentences, etc. makes IC documents unclear and incomprehensible. There are tools that can help, such as the Flesch-Kincaid readability index and the Syntactic Complexity Index (SCI). The Flesch-Kincaid is based on the correlation between text difficulty and word/ sentence length. A large number of syllables and words in sentences make them difficult to read. The SCI correlates the number of short sentences and the number of coordinating and subordinating clauses. Diagrams, different font types, text boxes, shaded symbols, etc. may be used to improve legibility. c i r e s p . 2 0 1 3 ; 9 1 ( 9 ) : 5 5 1 – 5 5 3

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@article{Lpez2013InformedCI, title={[Informed consent in surgery. Distance between theory and practice].}, author={Pedro Ruiz L{\'o}pez}, journal={Cirugía española}, year={2013}, volume={91 9}, pages={551-3} }