UK GMC guidance lacks detail

10 Jun 2008

Doctor warns that consent guidance lacks clarity

New guidance on taking patient consent may not improve medical practice, argues an expert today.

Professor Glyn Elwyn of Cardiff University, UK, states in the British Medical Journal that new General Medical Council (GMC) guidance, to be implemented this month, lacks essential details.

Obtaining consent from patients for medical procedures often takes place a few hours before the procedure, and "patients seldom have time to read, never mind reflect on, information about possible harms and benefits", writes Professor Elwyn.

He says that many clinicians view the process as a "perfunctory chore", but patients want to be given more relevant information about risks and consequences. The fundamental aim of informed consent is that "patients should be neither coerced nor deceived", he writes.

This new GMC guidance advocates the communication of risks, gives advice for when patients refuse treatment, and incorporates legal safeguards for patients who are unable to make their own decisions.

At first reading, the guidance seems to signal a cultural change in how informed consent should be achieved, writes Professor Elwyn. "Yet closer reading reveals broad brushstrokes - details are sparse and the advice remains non-specific.

"For example, the guidance provides no detail about suggested risk thresholds for specifying the probability of harm; in addition, it makes no suggestions on how to achieve balance, how to tailor information, or how to explore personal preferences."

Professor Elwyn fears that the lack of detail might prevent many clinicians from making major changes to their practice, and calls instead for "systemic and cultural change" to make shared decision making "a requirement at the organisational level, integrated into the way multidisciplinary teams are set up to provide care".