I am a little concerned about the use of the phrase “fully informed consent” in standard 5.5 of the draft Osteopathic Practice Standards document. Whilst this is a sensible ideal, like most ideals it is a practical impossibility and its inclusion could inadvertantly create enormous problems for the profession.
There will always be information that is not available and it is impossible to cover all of the relevant information in the time available. Can osteopaths really be expected to give their patients all of the information that is necessary to make a fully informed decision in the literal sense? What if there is a piece of research that came out the same day that we are unaware of? What if omit to explain every last detail of the competing theories for how the technique we plan to use works? What if we forget to tell them what we had for breakfast? How are we to determine how much information is necessary for consent to be fully informed?
This is especially important in the Code of Practice, which sets the legal standards by which osteopaths are judged in PCC hearings and will need to be consistent with the Practice Standards document in its wording. If this wording is used in the Code of Practice, it will put every osteopath in breach of the literal meaning of the Code and make it impossible for any osteopath to win a PCC hearing regarding a communication issue, as a lawyer will be able to argue that any amount of information provided to a patient falls short of what is necessary to make a “fully informed decision.”
Please join me in asking the GOsC to change the wording.
Ben Katz
I think the problem of “informed consent” is a problem of the law, rather than a problem of GOsC regulation. Yes, I think the consent law doesn’t work and is actually harmful to patient care, but it is the law, and I don’t see that the GOsC can have any alternative but to require us to obey the law.
This is a problem for all healthcare professions, and I would like to see all the professions join together in asking, publicly, for a revision in the consent law.
The current situation in England and Wales is a result of case law, and my guess (as a non-lawyer) is that it would take either an Act of Parliament or a successful appeal to a higher court to change it. Neither process would be risk-free – you can never guess which way an appeal court may jump, and Parliament is quite capable of producing a statute which is even worse than what we have now. (Though I can’t quite think how!)
The issue here is not whether the GOsC should require osteopaths to obtain informed consent. Obviously our regulator needs to ensure that we act within the law. However, the inclusion of the term “fully informed consent” goes beyond the letter of the law and holds us to a standard that is both impracticable and unenforceable.
The General Dental Council, in their guidance on consent, states that “For consent to be valid, the patient must have received enough information to make the decision. This is what we mean by ‘informed consent’.”
This seems like a much clearer and more sensible approach to me.
Ive always wonderd how empowered a patient can be to make an “informed decision” when they are usually undressed, lying passively, often in pain, with an “expert” advising them on what may or may not be best for them. Seems to me this is possibly the most innaproriate time and place for a patient to weigh up the information and make an informed choice about treatment.
As osteopaths we may strive to inform the patient, but might this information often be redundant given the context that its given and the patient’s (in)ability to process it.
Just a thought.
Good point Rick.
What is this…..exercise in fantasy!!!……Do you think that every time a Doctor, that is a medical Doctor gives a perscription he tells the patient all of the possible dangers?
For example NSAIDs….like haemeragge..and death.
Or Vaccines…..like brain damage and or flu like symptoms!
I could go on…but will not bore you.
The doctors I know (and they are considered good Doctors) do tell me that they routinly DO NOT…I will not divulge their names otherwise they risk being struck off
So we are expected to scare the living Sh**te out of someone before treating them.
With their clothes off and in pain.
…That is political correctness…!!!!do I tell my patients……now going over 40,000
about the potential damage, CVA, and death that may occur if I touch them…..of course I do!!
Is you see a GP they may look at the other medication you are taking and then talk that through with you. The pharmacist will also tell you about the medication and there is a leaflet on with the medication. So I don’t think it is a like for like comparison. With medication there is also a yellow card system for side effects so there are systems in place to capture side effects from medication.
GOsC does not set the content for regulation, this is done else where outside the profesion and GOsC roles to feed that through to us to implement into our systems. At the moment many of the patient user groups are being trained to be very critical of what to expect from any health care professional. And if we are to be professional we need to comply.
With MRSA there is a website saying that you should see your practitioner wash their hands. For me this posses a dilemma as this is what I do when I leave the room for the patient to undress.
We need to be mindful of what regulated professionals are signed up to complying with.