For the doctor-patient partnership to be effective, both parties have a role to play in making decisions about treatment or care. Doctors must give patients the information they want, or need to know, about their diagnosis and prognosis, and the treatment options available to them. Patients are then more able to make decisions that are appropriate for them.
Discussions should be tailored to the individual patient. Some patients want a lot of detail; other patients - like Suzie, initially - prefer not to know much at all. Doctors must respect patients' wishes as far as possible, and should not force information on them, but must provide at least the amount necessary for the patient's consent to be valid. Consent can still be accepted as long as the patient has a general understanding of what the proposed investigation or treatment is intended to achieve, what it will involve, whether there are any serious risks, what problems might arise afterwards, and what can be done to minimise any pain or discomfort.
However, if a patient insists that they don't want even this basic information, the doctor should explain the potential consequences of that decision, particularly if it might mean that the patient's consent would no longer be valid. In Suzie's case, Dr Austin explains that she really needs to know about the risks of the procedure, and what problems to look out for after having the mole removed. The doctor should also make a note of the patient's decision.
All doctors know that our medical practice is affected in some way by our limits on time or other resources. Finding a way to make best use of those resources can be a challenge, particularly when doctors have to balance the needs of the individual patient with those of all the patients using a particular service.
Where time pressures prevent them from spending as much time with patients as they'd like, doctors should consider what other means they could use to ensure that patients have all the information they want or need about their condition and any proposed investigation or treatment. Clear, up to date written information - like the leaflet on melanoma that Dr Austin gives to Suzie - can be very helpful, as can details of good quality online or other reference sources.
Doctors don't practise in isolation, and they may wish to explore what role other members of the healthcare team might play in providing patients with advice and support. It's appropriate that Dr Austin offers to introduce Suzie to one of the nurses in his department who also can discuss Suzie's diagnosis with her.
Before accepting a patient's consent to treatment, the doctor who will be providing the treatment must be satisfied that the patient's consent is valid. A signature on a form does not, of itself, confirm that this is the case. If a patient has consented to a planned investigation or treatment, but still has questions or reservations about it, the doctor providing that treatment should make sure that these concerns are properly addressed.
The law requires that written consent must be obtained for certain procedures, such as fertility treatment. It's also regarded as good practice to have confirmation in writing of consent from patients if, amongst other things, the investigation or treatment is complex or if it involves significant risks.
Doctors often talk about "consenting" patients. While this may be a convenient shorthand term, it gives the impression that seeking consent is an end in itself, and something that doctors do to patients. "Consenting" is also frequently seen as an administrative task, to be delegated to a junior member of the team.
In our Consent guidance, the GMC makes clear that discussing consent should be an integral part of the consultation with the patient. It's the responsibility of the doctor who is performing an investigation or providing treatment to ensure that the patient has given valid consent.
The doctor can delegate the responsibility for seeking consent, as long as the person to whom they delegate is suitably trained and qualified, well enough to answer any questions that the patient may have. That would include understanding the treatment, and the risks attached to it.
However, it's the doctor doing the procedure that remains responsible for ensuring that the patient is given enough time and information to make a valid decision.