Monday 6 August 2007


I enjoy teaching medical students. Mostly, they're bright eyed and bushy tailed, keen to learn what they can from their short time in their placement. Last week I was pleasantly surprised at how much reading around the subjects they'd done. For undergraduate students their level of knowledge was good, their understanding was good, their questions were sensible.
Much goodness.

Last week I also taught the new cohort of junior doctors. Years ahead of the medical students, in terms of postgraduate training and experience, they were less bright eyed and bushy tailed. I'll forgive them that since they'd had inane lectures about lifting and fire extinguishers and the like that had driven them to catatonic states.

What surprised me was their understanding of assessment of capacity to consent to treatment. It was less than ideal. This was somewhat disheartening. Making sure that your patient can consent to what you're proposing is, obviously, a key task that doctors have to be adept at and use many many times every day. It's so central to our work it's seen as a Core Skill that medical students must know (and, indeed, they did). Many junior doctors were not adept at this process.
Much badness.

Just to summarise what the process is, for those who may be curious, the British Medical Association and the Law Society in 2004 generated a document clarifying standards for determining if a patient could consent to treatment. It's simple and surprisingly common sense :
• Understand in simple language what the medical (or other) treatment is, its nature and purpose, and why it is being proposed.
• Understand its principal benefits, risks and alternatives.
• Understand in broad terms the consequences of not receiving the proposed treatment.
• Retain the information long enough to use it and weigh it in the balance in order to arrive at a decision.
• Make a free choice.

I'm pleased that medical students are up to speed with this. I'm less pleased that some practising medics aren't.

I wonder of GP Registrars fair better, with more reflective practice? Non-medical prescribers I've mentored through their courses over the last few years (nurses and recently physio's too) have had mixed understanding of determining consent. If folks wishing to become prescribers can have a lack of clarity on this, I wondered how what Dr Crippen calls Nurse Quacktitioners make of this. All my senior nurse colleagues in the community were very clued up on determining consent.


I am happy once again.

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