56 - EVALUATING THE EFFICACY OF SURGICAL CONSENT

Objectives: Patient autonomy is arguably the most important of the core values of medical ethics, yet the process of obtaining surgical consent has remained one of the lesser scrutinized areas of modern surgical practice. Informed consent implies a patient’s understanding of nature of the operation, indications, risks, benefits, and alternatives, as well as a rudimentary understanding of the technical nature of the procedure. Surgical consent has traditionally been obtained through verbal communication with the patient and formalized by acknowledgement in a signed legal document. This process oftentimes leaves patients unequipped with adequate knowledge about the procedure they just consented to. In the majority of cases, it is simply impossible for the non-medically trained layperson to fully understand the nuances of surgery in a practical face-to-face conversation. While some may argue a certain degree of paternalism may be inevitable, we believe there is vast room for improvement in the surgical consent process.

Methods: We chose to examine English-speaking adult patients undergoing some of our most common procedures (laparoscopic cholecystectomy, open inguinal hernia repair, and soft/soft tissue excision). We asked 71 patients to complete a free response survey on the risks, benefits, and alternatives to the operation they had just consented to undergo. The patients were administered the survey either in the outpatient clinic, or in the preoperative area immediately before being rolled back for surgery.

Results: Three patients were able to complete the survey in both settings. The majority of the patients had shockingly little insight into the risks of their respective procedures. The responses demonstrate that patients tend to lack an understanding of surgical risks in particular, especially when it comes to complex issues such as common bile duct injury after laparoscopic cholecystectomy.

Conclusion: This study highlights key deficits and potential areas of improvement in the informed consent process. Areas of future improvement will entail improved preoperative education and “ticklers” for retention to create a more standardized, rigorous process that equips patients with the knowledge needed to make an informed decision.