Should medical students attempt to get consent?
BURGER/PHANIE/REX
Medical students often help out in theatre, but may not
attempt to get a patient’s consent first. This is a lawsuit waiting
to happen, says Alexander S J Shaw
Medical law is difficult to
understand without an appreciation and full understanding of the scale and
importance of consent. Through spending time on the wards and in the
theatres, medical students learn the need and legal importance of consent.
I wonder whether we truly know the laws of consent, however. I would go as
far as to ask whether all doctors do. The true breadth of the term
“consent” is not fully appreciated and has become yet another
automatism in the profession.
Still failing to ask
Many situations arise for which doctors and medical
students are required to get consent. In clerking and performing procedures
on conscious patients, it is obvious that we need to get informed consent.
But at other times, consent is neglected. We learn and seem to appreciate
that without consent any procedure or examination is deemed as battery and
assault—a prosecutable offence. Consent therefore legitimises an
otherwise unlawful act. But we still fail to extend the act of gaining
consent fully into clinical practice. As students we are still bound by the
laws of consent as any other professional; we have no right to touch a
patient without their permission.
Not too bothered
At medical school, we all hear about students
examining patients who are under general anaesthesia. We discuss these
incidents and frown with distaste, as we know it to be morally, ethically,
and legally wrong. But I notice that we are still comfortable to scrub up
for surgery to help in an operation—an act still deemed as assault
without informed consent. We do not get this consent and we cannot be
considered a part of the consultant’s team, since we are not
qualified. As such, our presence is only of benefit to us and our learning.
The patient makes no positive gain. The surgeon may have consent. But
nowhere on the form signed by the patient does it say a student can help in
the operation, even for basic tasks such as suturing. Never, in my
experience, has the surgeon talked to the patient about a student’s
presence beforehand, in case there is a procedure we can help with. But we
still end up doing procedures that if done wrong could have detrimental
effects on our patients. Again, we have no qualms stepping forward to
catheterise a patient under general anaesthesia without prior consent
because we fear the consultant’s response.
What if we asked?
One day, a patient may become aware that a student has
taken part in an operation and, although without any apparent physical,
psychological, or economic loss, may still allege that there was no
consent. The patient is well within their rights to claim that the level of
information given to them was insufficient, and the court may well agree.
But would the patient have refused even knowing this extra information,
that we as students may be involved directly? We do not know because we do
not ask.
What should change?
Shouldn’t we be stepping back and changing the
way we act? Trust is a luxury that has to be earned, and we cannot enter a
profession and expect this to be our automatic right. Should we not be
taught from as early as day one about these often overlooked facts? How
much time would it take for students to gain consent from the patient
before their surgery, thus pre-empting such events? And then if the
situation arose of a surgeon requesting our help, legally and ethically all
would be correct and proper. This could well avoid a law suit.
Learning consent
Teaching the new generation of doctors the full meaning
of consent, as early as the first weeks of medical school, is surely
appropriate. One model might be the policy developed at one London medical
school as set out in a previous BMJ editorial.1
The medical profession today is threatened with
litigation, but it still seems to overlook the fact that medical students
may enter the profession with their own fixed understanding of medical law.
This is hard to change, unless changed from an early stage.
No one disputes the importance of ethics and law in our
teaching programmes, but no one checks to see if we truly understand it.
And apparently not even qualified doctors, be they new or old, notice this
lapse, which begs the question of what other legal lines are we dangerously
flirting with?
Alexander S J Shaw , fourth year medical student, Royal Free and University College Medical School
Email: alexander.shaw@ucl.ac.uk
studentBMJ 2005;13:309-352 September ISSN 0966-6494
- Doyal L. Closing the gap between professional teaching and practice. BMJ 2001;322:685.
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Responses published this month
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Articles
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Responses
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EDUCATION
Should medical students attempt to get consent?
Alexander S J Shaw (Sep 2005)
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Keith Chiu
(September 9th, 2005)
Read this response
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EDUCATION
Should medical students attempt to get consent?
Alexander S J Shaw (Sep 2005)
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Keith Chiu
(September 9th, 2005)
4th year medical student
,Warwick Medical Schoolk.chiu@warwick.ac.uk
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I could not agree more with the article by Alexander Shaw for the need for medical student to learn about the full meaning of consent.
As a medical student in Warwick, we have both formal teaching and practical OSCEs on this topic. In my personal experience, patients are more than happy to consent to allow medical students to “use” them as teaching materials and consent has usually been seek one way or another, albeit on their appointment letter, a notice in the waiting room or verbal consent by medical staffs or by the medical students themselves.
I, however, would like to draw the distinction between seeking consent for the presence of procedures, such as surgery and consenting of a medical/surgical procedure by a medical student. Personally, I think that students should learn and ask for consent for the former as early as possible. As for the latter, gaining experience by observing should be encouraged but the act itself should be reserved for the medically qualified only, as they are ultimately legally responsible.
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