Letters Who will operate on you?

Pooled waiting lists and the validity of consent

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6196 (Published 21 November 2016) Cite this as: BMJ 2016;355:i6196
  1. David E Ward, retired cardiologist and electrophysiologist
  1. London W1G 7JG, UK
  1. drdavideward{at}hotmail.com

Sokol’s article on patient consent1 raises the issue of the validity of a “pooled waiting list” system for surgery or interventions. In such a system a group of operators select patients from a single list (perhaps after accounting for risk). This system is intended to minimise discrepancies between the lengths of different operators’ waiting lists and to improve efficiencies. Because operators’ methods, techniques, expectations, and counselling can vary considerably—and in my experience as a cardiologist often do—the pooling system may have an important impact on the meaning and validity of consent.

As an interventional cardiologist and electrophysiologist I resisted pooled waiting lists precisely because it was very likely to invalidate the consent process, not to mention continuity of care and other difficulties.2 A patient should have the incontestable right to meet the operator for a discussion before getting anywhere near the operating room. If that is not possible for unavoidable reasons then the procedure must be deferred. There is much more to the consent process than a signature (see Montgomery v Lanarkshire Heath Board, 2011). Two years ago I sought advice from the BMA about possible ethical and medicolegal problems associated with pooled waiting lists. That I am still awaiting a response perhaps illustrates the intricacies of my query.


  • Competing interests: None declared.


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