New consent guidance for doctors

By Adam Brimelow
Health correspondent, BBC News

The issues were explored in a play

The General Medical Council is calling for a fresh approach in the way doctors seek patient consent for treatment.

For the first time it sets out the need to share information on side effects and risks, and outlines good practice for patients with dementia.

And doctors are expected to help patients consider their options.

The British Medical Association has backed the guidance but says it will be difficult for doctors to find the time needed to deal with each patient.

The guidance was prepared with the help of National Theatre actors who performed scenes raising the issues of patients, carers and doctors to patients.

The GMC play, Forecast Fog, follows a character, with early-stage dementia, Will, through a series of unsatisfactory encounters with doctors.

In the first scene, his hard-pressed GP keeps talking to his carer, rather than addressing him.

"You can ask me you know," says Will.

"I do still have some grey matter up there."

Excluded

It was a poignant reminder for 61-year-old Ken Clasper, from Chester le Street in County Durham, who has early stage dementia.

Doctors need to engage more with patients in order to make good decisions Jane O'Brien General Medical Council

He had a similar problem with a GP who kept speaking to his wife, Janice, and excluding him from the conversation.

"I felt as if I was kept out of the equation at the time," he said.

"It was disrespectful really. It was as if I wasn't in the room."

On a later occasion Ken went to see a consultant for a problem unrelated to his dementia.

But he said the doctor told him he looked like there was nothing wrong with him and would not allow Janice in.

Afterwards Ken could not recall important details of the consultation.

"I wasn't very amused because his attitude was very arrogant and I can't tell how anybody can assess a person for Alzheimer's or dementia just by looking at them," he said.

"It is not like they have got a broken leg or anything else that is obvious.

"Because most people with dementia in the early stage look quite normal and act normal."

Changing relationship

The GMC guidance updates earlier publications on consent to reflect the changing relationship between doctors and patients - with the decline of deference and demands for more information - so decisions can be taken in partnership.

The play dealt with tricky issues

GMC head of standards and ethics Jane O'Brien said for some it would mean a change in mind-set.

"We would like to remind doctors and get them to see that consent is what the patient does, not what they do," she said.

"And that they need to engage more with patients in order to make good decisions."

The BMA has backed the guidance - but there are misgivings.

BMA medical ethics committee chairman Tony Calland said: "It's another burden that will be put on doctors and to some degree patients.

"And it may well be that not so many patients go through the system as quickly as they have done in the past.

"But it is important that each patient has a full understanding of what is being proposed on their behalf by their doctor and it is a real tension."

Lively exchanges

Despite the difficult issues in the guidance, the play is funny - but also provocative.

It prompted lively exchanges in the audiences as it was performed up and down the UK last summer.

Jane O'Brien said using theatre in this way for a public consultation had been a fantastic success.

"I think it was an effective way of giving patients and carers a voice, particularly those people that would not find the time or the inclination to respond to long written questions, or even to think about things in the abstract."