Informed Consent for the Orthopaedic Surgeon

Abstract

In the United States, orthopaedic surgeons have a legal obligation to obtain informed consent from patients before performing surgery; it is a process that includes a signed written document.There are specific legal requirements that vary somewhat by state but generally include disclosure and documentation of the diagnosis, an explanation of the recommended procedure, a conversation about the risks and benefits of the procedure, and a discussion about alternative treatments.Inadequate disclosure of risks and alternatives is associated with increased indemnity risk.Studies have shown that many consent processes and forms are suboptimal.

Poor compliance documenting informed consent in trauma patients with distal radius fractures compared to elective total knee arthroplasty

“…The process embodies the ethical principles of autonomy, beneficence, and non‐maleficence 28 . While the importance of informed consent has been enshrined in medicine for several decades, there are still many challenges to implementing the process effectively 1,2 . Modern medicine has shifted the focus of consent away from the Bolam principle, which was based on the collective opinion of experienced medical practitioners, towards the specific needs of a patient 5,29 .…”

“…Modern medicine has shifted the focus of consent away from the Bolam principle, which was based on the collective opinion of experienced medical practitioners, towards the specific needs of a patient 5,29 . With this patient‐centred approach, a surgeon is now required to explain all significant operative risks that a reasonable person in the patient's position would be likely to attach significance to 2,26 . This has since been refined through rulings such as the Roger v. Whitaker case in Australia 30 and the Montgomery v. Lanarkshire Health Board case in the United Kingdom 31 .…”

“…Healthcare professionals have an ethical, legal and regulatory requirement to obtain informed consent prior to any treatment. Although informed consent is a long‐standing practice in medicine, the process of informed consent is evolving, and there remain challenges in implementing it effectively 1,2 . Not all physicians recognize the importance of informed consent, particularly in the field of orthopaedic surgery, where failure to obtain and document consent is a frequent cause of claims 2–5 …”

“…Many articles have been published on informed consent; however, there is a paucity of those focused on orthopaedic trauma patients 9–14 . The process of obtaining informed consent in the setting of trauma is challenging and is complicated by time constraints and patient distress 2,14 . It is frequently tasked to a junior doctor to complete and document the consent process in the emergency room or the pre‐operative holding area 9,14 .…”

Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit

“…Therefore, it is the belief of the authors of this departmental audit that these basic features are often lacking on the consent forms signed by patients in our tertiary referral centre for orthopaedic trauma [8]. The purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the 'Orthopaedic Surgical Consent' standards, as set by the American Association of Orthopaedic Surgeons (AAOS).…”