Please note this is not an exhaustive list of recommendations, but some key learning points from our analysis:
Ensure your surgical technique is regularly updated and in line with current best practice.
Discuss the possible benefits and risks of all potential surgical or conservative treatment options. Consider what is most important to that individual, taking into account their current employment and lifestyle. Take time to explore this with each patient – for example, one patient may consider a 1% risk of worsened pain acceptable, but another may not.
Explain frequent and serious complications, including the possibility of chronic pain, and the implications if these occurred. Explain what you would do to manage any complications or failure to meet their expectations.
Listen to what your patient considers a successful outcome. Understand their concerns and clarify whether or not it is likely you can meet their expectations.
Document all discussions thoroughly and contemporaneously.
For elective operations always leave sufficient time – at least a week for example – after the consultation before scheduling the procedure. This gives the patient time to consider their options thoroughly, to talk to friends or family, access more information, and ask any follow up questions.
Do not assume that another practitioner, who may have reviewed the patient before your consultation, has had an informed discussion with the patient about all the options, especially the option of conservative management. It may be tempting to consider that the patient has already considered and rejected conservative management by the fact they are consulting with a surgeon, but our analysis of common themes leading to dissatisfaction suggests this is not the case.
Double-check your patient’s understanding of the information and make sure decisions have been accurately informed.
Remember consent is a process and not simply a signature on a form.
Where costs are involved, your patients should be given clear information about ALL the costs and what their rights are to refunds/return of deposits if they change their mind after they’ve paid some or all of the costs.
Ensure a perioperative management plan is in place, including assessment of venous thromboembolism risk and the care of any other medical conditions, such as diabetes.
At discharge, review the requirement for ongoing anticoagulation as necessary.
Ensure any postoperative deterioration, complication or falls are communicated, investigated, and managed in a timely and appropriate fashion.
Consider the Medicines and Healthcare Products Regulatory Agency Guidance when following up on patients with metal-on-metal hip replacements.
Demonstrate empathy in your consultations and show your patients that they are the focus of your attention.
Remember that accurate and clear documentation is the cornerstone of any medicolegal defence. It’s often relied upon years after the event.
Ensure you’re fully indemnified to carry out the relevant procedure in the UK.