Intended for healthcare professionals


Patient consent—decision or assumption?

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1259
  1. Glyn Elwyn, professor
  1. 1Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff CF14 4YS
  1. elwyng{at}

New guidance from the General Medical Council urges a change in approach

The process of obtaining consent from patients for procedures such as surgical operations has been described as “the modern clinical ritual of trust,”1 although its real meaning and performance are still debatable.2 Last week, the General Medical Council released new guidance on the subject, Consent: Patients and Doctors Making Decisions Together, that will be implemented in June 2008.3

To caricature, obtaining consent often involves a junior member of the clinical team being charged with obtaining a signed piece of paper declaring that the patient has understood the nature of the procedure and its consequences. Consent is often completed a few hours before the intended procedure, and patients seldom have time to read, never mind reflect on, information about possible harms and benefits—rare or otherwise.

Although the consent discourse has hardly been studied in depth, many clinicians report the process of obtaining consent from patients as a perfunctory chore—to be accomplished in a superficial albeit efficient way—to ensure a smooth transition from preoperative assessment to preparation for the operating theatre. In the real world of rapid throughputs and turnaround times, consent is—and often has …

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