Palmo Anest

Surgical Consent

I wonder how does this done in other hospital.

In my hospital, it is usually done by the house officer who sometimes have no clue what the said surgical procedure is or how it is suppose to be done and also the risk involved.

The usual way a house officer takes the consent is like e.g.:

HO: Pakcik, besok nak operate kan?

Pakcik: Ya kot...

HO: Sign sini pakcik, untuk operation.

(Consent taken from patient)

When the anest doc does his/her premed round, if he is a lil chatty, the patient will starts asking a lot of questions that the surgical team would have answered to the patient's satisfaction in the first place...

We have an incident recently.

A 18 y.o. young man was admitted for appendisectomy. The consent was taken from the 'sister' of the patient. The surgical went on with some complication, the patient had to be admitted to ICU for post op care.

In the ICU, patient's family is very furious, not about the complication, but the said 'patient's sister' was actually not their family member! Although the patient and the lady who sign the consent had lead the HO to believe that she is the sister, it is still very important that the HO knows for a fact that the patient being a 18 y.o. adult, should sign for his own consent.

We have been bring up the issues of surgical consent to respective head of different surgical base units for as long as i can remember but it was never really taken seriously.

HO who made a mistake comes and goes. The issues remain years after years. I think it is an important issue to be discussed in the new HO's induction course rather then keep stressing on how to dress and what to dress and some other nonsense they are imposing in the current induction.

Guess what is the usual knee-jerk-reaction of the bosses whenever there is a mistake done by the lower ranking officer? Simple, strike it off. If HO make a mistake, HO cannot perform the said procedure anymore without MO's supervision. When a ward nurse made a mistake, they too don't have to perform the task anymore, call the HO for the said task... Bottom line is, don't create issues... then the bosses can have good life sitting on top of the food chain.

I have seen a senior consultant taking a very detail consent from the patient and the fortunate MOs can really learn and felt shameful of how a proper consent supposed to be taken.

That reminded me that very soon, we in m'sia public hospital would needs to take a separate written anaesthetic consent in detail from every patient coming in for surgery. That would add another 10-15 minutes to every patient when we do our premed rounds.

posted by LT @ 12:49 AM