The Do’s and Don’ts of Informed Consent.

Get informed about informed consent!

In our modern world where information is more accessible than ever and people have a certain amount of autonomy and responsibility to make informed decisions, the paternalistic doctor-patient relationship is a thing of the past. It has been replaced by a model of patient autonomy, which when done properly, is mutually beneficial for patients and practitioners. Commercial interests that can sometimes seep into the aesthetic medicine field have contributed to an eroding trust between patients and practitioners. Coupled with a larger variety of treatment options, greater access to information, and the liability that practitioners assume when a procedure goes unexpectedly or expectations are not properly managed, can lead to serious harm for both parties. This is why the patient must be a partner in decision making and proper informed consent is essential. Below are the do’s and don’ts to obtaining proper informed consent.

The 7 Tenets of Proper Informed Consent

Collecting a patient’s signature on a generic consent form does not constitute obtaining informed consent.  Adhere to the following 7 steps to ensure proper consent is obtained.

1. Ensure the form contains the exact nature of the condition and procedure
1. Outline the procedure / treatment in detail and do not leave any blanks
2. Use different forms specific to different types of procedures, for example Botulinum Toxin vs. Laser procedures
3. Consent should be sought even for minor procedures – in fact, the only thing a practitioner can do without consent is an examination, as consent is implied by the patient seeking a consultation
2. Outline alternative treatments and options
1. Transparency around other options for treatment, their comparative cost, and effectiveness is paramount, regardless if this may affect the  revenue of the practitioner
3. Clearly present all associated and possible risks with the procedure
1. A good way to do this is by quantifying risks and presenting the probability of something occuring, for example “there is a 1 in 200 chance of X happening”
4. Make your best efforts to assess the mental health of the patient
1. In order for the patient to provide their consent, they need to be of good mental standing. This includes ensuring the patient is not inebriated or under the influence of drugs
2. Screening for body dysmorphic disorders prior to treatment should also be considered. It is rarely done due to the complexity of proper diagnosis, a lack of formal processes and supports for practitioners, and the ongoing mutability of the disorder itself, but consideration of the mental health of patients is important prior to administering treatment to ensure the best outcomes for both the patient and practitioner. For more information on this topic and guide for screening, read our article: What is Snapchat Dysmorphia? The perilous path from filters to fillers.
5. Ensure the consent form is legally binding 
1. Inform yourself of the laws of your country of practice and standardize consent to those laws
2. The form must be signed by the patient, practitioner and a witness – and in the case of a minor, a parent or legal guardian
6. Ensure the consent form is accessible
1. The procedure must also be outlined in accessible, layperson terminology in a language they understand. Consider having copies of the consent documents translated into the major regional languages of your area of practice – your professional association may provide support for this
7. Consent may be revoked at any time
1. Conset can be withdrawn at any time and any refusal of consent must be duly recorded. This is termed informed refusal

Disclosure, proper explanation of alternatives and risks, and conferring understanding are the key tenets in the process of informed consent. Failure to comply can result in real health and legal consequences, including charges of malpractice, negligence, an assault and battery for the practitioner; “most malpractice claims in cosmetic plastic surgeries are not a consequence of technical faults but because of inadequate selection criteria of the patients and lack of adequate communication between the patient and the surgeon” (Nejadsarvari et al., 2014). Follow the above rules to ensure obtaining proper informed consent and a favourable outcome for all parties. 

References

References

Kapoor, Lalit. “Informed Consent in Aesthetic Surgery.” Journal of cutaneous and aesthetic surgery vol. 8,3 (2015): 173-4. doi:10.4103/0974-2077.167284

Nejadsarvari, Nasrin, and Ali Ebrahimi. “Different aspects of informed consent in aesthetic surgeries.” World journal of plastic surgery vol. 3,2 (2014): 81-6.