Updated GMC guidance on decision-making and consent: implications for urologists

Abstract

We summarise the updated General Medical Council guidance on consent and decision-making. We explore the emphasis on enabling supported decision-making and the implications this has in day to day urological practice. In particular, we address some of the issues encountered in one-stop clinics, on pooled elective lists and with pre-written consent forms. The new guidance will emphasise the importance of sharing information relevant to your patient in light of the Montgomery ruling. Every decision is unique. We must appreciate the importance of the process of decision-making and understand our role as the clinician. Here we suggest some practical considerations to address the updated General Medical Council guidance. Level of evidence: Not applicable.

Montgomery's legal and practical impact: A systematic review at 6 years

“…A dominant claim in the literature on Montgomery is that it transformed the law of informed consent 3‐26 . For example, one paper suggests that ‘the Montgomery decision redefined the standard for informed consent and disclosure’ 7 .…”

“…One widely discussed possibility is that Montgomery could encourage defensive medical practices. This concern was noted and rejected by the Supreme Court in its decision, 1 but Case argues that the Court ‘gave short shrift to arguments based on the risk of defensive practice’, 100 and many others share her concern 7,20,36,53,60‐63 . For example, as Murphy comments, Montgomery could cause doctors to become ‘less concerned with genuine understanding and consent from the patient and more concerned with mitigating the opportunities for litigation’ 60 .…”

“…In response to this concern, many papers question the premise that Montgomery actually creates new burdens, highlighting that the GMC has long imposed similar disclosure requirements 4,7,8,17,19,20,25‐27,29,31‐34,36,38‐54,88‐90,99,101 . For example, Lamb argues that ‘it is unlikely that a slightly greater focus on the particular patient…will lead to any real practical impact on the day‐to‐day action of doctors’ 36 .…”

“…This concern was noted and rejected by the Supreme Court in its decision, 1 but Case argues that the Court 'gave short shrift to arguments based on the risk of defensive practice', 100 and many others share her concern. 7,20,36,53,[60][61][62][63] For example, as Murphy comments, Montgomery could cause doctors to become 'less concerned with genuine understanding and consent from the patient and more concerned with mitigating the opportunities for litigation'. 60 It is unclear whether this is actually happening, however, as our systematic literature review revealed no empirical studies on this issue.…”

“…Even if Montgomery significantly changed the law, some argue that its impact on doctors' duties is at most symbolic because the General Medical Council (GMC) has long imposed a similar patient-oriented professional duty of risk disclosure. 4,7,8,17,19,20,[25][26][27]29,[31][32][33][34]36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]88,89,99,101 The GMC's patient-centred duty was in fact highlighted by the Supreme Court in Montgomery, which cited passages from the GMC's 2008 and 2013 guidelines and noted that the 1998 guidelines that were in place at the time of Nadine Montgomery's pregnancy were 'broadly similar in effect' (although the lower courts may not have been aware of this). 1 The existence of GMC guidance is one reason that Lamb argues that the case has mostly 'symbolic' value, 36 but this account is challenged on three grounds in the literature.…”