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

48. You must respect your patient's right to decide. If their choice of option (or decision to take no action) seems out of character or inconsistent with their beliefs and values, it may be reasonable to check their understanding of the relevant information (see paragraph 10) and their expectations about the likely outcome of this option and reasonable alternatives. If it's not clear whether a patient understands the consequences of their decision, you should offer more support to help them understand the relevant information. But you must not assume a patient lacks capacity simply because they make a decision that you consider unwise.

66. If a patient has chosen an option but doesn't want to discuss the details, you should explain they will need to have some information about what it would involve before you can proceed, such as:

a. whether the procedure is invasive
b. what level of pain or discomfort they might experience and what can be done to minimise this
c. anything they should do to prepare for the intervention
d. if it involves any risk of serious harm.

21. You must give patients clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action.

23. You should usually include the following information when discussing benefits and harms.

a. Recognised risks of harm that you believe anyone in the patient's position would want to know. You'll know these already from your professional knowledge and experience.
b. The effect of the patient's individual clinical circumstances on the probability of a benefit or harm occurring. If you know the patient's medical history, you'll know some of what you need to share already, but the dialogue could reveal more.
c. Risks of harm and potential benefits that the patient would consider significant for any reason. These will be revealed during your discussion with the patient about what matters to them.
d. Any risk of serious harm, however unlikely it is to occur.
e. Expected harms, including common side effects and what to do if they occur.

(Decision making and consent, paragraphs 48, 66, 21 and 23)

You must make good use of the resources available to you.

(Good medical practice, paragraph 18)