Working with doctors Working for patients

 

Introduction

Suzie, who is 30, is concerned about a large mole on her leg which has changed colour and begun to itch. Suzie's GP has referred her to a dermatologist, Dr Austin, for further investigation.

Dr Austin has examined Suzie's mole and recommended that she have it removed so that it can be tested.

Dr Austin

Dr Austin

It's quite straightforward; we can do it here under local anaesthetic. You'll need two or three stitches, which...

Suzie

Suzie

Will I have to take much time off?

Dr Austin

Dr Austin

No, it'll only take a few minutes, and you can go straight back to work afterwards. There's a small risk of bleeding initially, but...

Suzie

Suzie

Stop, please. I realise I need to have this thing removed, but I don't want to hear about bleeding and stitches. I'll go ahead, just spare me the gory details.

What should the doctor do...? (Select A,B or C)

A

Respect the fact that Suzie doesn't want any more information about the procedure, and arrange an outpatient appointment for her?

B

Tell Suzie that he cannot arrange the procedure until he is sure that she understands exactly what it involves, and what the risks are?

C

Acknowledge that Suzie doesn't want to know in detail about the procedure, but explain the importance of her knowing basically what it will involve, including any serious risks, and what to do about any problems afterwards?

Dr Austin

See what the doctor did

Dr Austin explains to Suzie that, while he won't force information on her that she doesn't want, there are certain things, including risks, that she really needs to know about - for example, how soon the stitches can be removed and which symptoms (such as bleeding, continued soreness) might warrant getting the mole site checked by her GP in the meantime. He makes an outpatient appointment for her to have the mole removed.

References

If, after discussion, a patient still does not want to know in detail about their condition or the treatment, you should respect their wishes, as far as possible. But you must still give them the information they need in order to give their consent to a proposed investigation or treatment. This is likely to include what the investigation or treatment aims to achieve and what it will involve, for example: whether the procedure is invasive; what level of pain or discomfort they might experience, and what can be done to minimise it; anything they should do to prepare for the investigation or treatment and if it involves any serious risks.
(Consent: patients and doctors making decisions together, paragraph 14)

Clear, accurate information about the risks of any proposed investigation or treatment, presented in a way patients can understand, can help them make informed decisions. The amount of information about risk that you should share with patients will depend on the individual patient and what they want or need to know. Your discussions with patients should focus on their individual situation and the risk to them.
(Consent: patients and doctors making decisions together, paragraph 28)

You must tell patients if an investigation or treatment might result in a serious adverse outcome9, even if the likelihood is very small. You should also tell patients about less serious side effects or complications if they occur frequently, and explain what the patient should do if they experience any of them.
(Consent: patients and doctors making decisions together, paragraph 32)

You must make good use of the resources available to you.14
(Good Medical Practice, paragraph 18)