Medical Case Reports

Accuracy of documenting complications when consenting patients for laparoscopic appendectomy

Background: Correctly performed informed consent acts as a shield against complaints by patients and claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting. The purpose of this study is to compare the variations in consenting practice amongst Foundation Year 2 Doctor (FY2), Core Surgical Trainees (CT) and Specialist Registrar (SpR) for Laparoscopic Appendectomy with specific reference to the documentation of significant risks of surgery.

Methodology: A proforma was devised which included information like significant and/or commonly recognized complications of Laparoscopic Appendectomy as well as grade of the consenting medical professional.  The proforma containing 10 standard complications five major and five minor) was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted.

Findings: The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32 (84.21 %) were completed by Junior Grade Doctors out of which 15 by FY2 and 17 by Core Surgical Trainees and 6/38 (15.78 %) by SpR. Of the set standard 10 complications, FY2 documented an average of 4.2, Core Trainees documented 6.2 and ST3+ documented 8.16 complications.

Conclusion and Significance: There is a need of improvement in the documentation of complications especially among Junior Doctor which require proper intervention either by conducting a consenting workshop or using a Procedure specific consent (PSCF) which can significantly improve consenting practice for a standardized list of complications and act as a source of information for the patient and a prompt to discuss the risks.

Bishow Bekhyat Karki