EDITOR - We measured the period of time a predominantly elderly group
of patients spent reading the surgical consent form before signing it. The
low number of patients found to read the form (1%) supports the need for
improved regulations as advocated by Goss1.
Prior to surgery, all patients must receive a simple non-technical
explanation of their intended treatment to enable them to make informed
decisions about their care2. The signed consent form documents the
patient's agreement to surgery and the doctor's affirmation that the
procedure has been explained. Since patients frequently have a limited
recollection of preoperative discussions3 and experience difficulty
reading the small typeface of consent forms4, we investigated the time
patients, who were able to read the consent form, spent doing so before
signing it.
100 consecutive patients attending a pre-admission clinic prior to
cataract extraction were assessed and received a standardised explanation
of the procedure from a single ophthalmologist. They were invited to read
and then sign the surgical consent form and the surgeon completed paper
work whilst they did so. The time they spent reading the form before
signing it was recorded to the nearest five seconds. Their near visual
acuity was measured with a near vision chart, which consists of text
printed in increasingly small typefaces5, and only patients able to read
the form (N10) (using their prescribed reading spectacles) were included
in the study.
Although all 100 patients (mean age 73 years) had sufficient near vision
to read the consent form, only one spent more than 5 seconds doing so.
This confirms the clinical impression that the majority of patients do not
read consent forms even when specifically invited to do so, reflecting
perhaps the high level of trust patients have in their doctors. Although
the time spent reading a form is not necessarily correlated with the
ability to recall its contents, cursory examination of a form that takes
over a minute to read is unlikely to facilitate long-term recollection of
the salient details. The fact that only one per cent of patients able to
read the consent form spent longer than five seconds doing so may prove to
be of importance, particularly if the outcome of treatment falls short of
a patient's expectations. We therefore endorse the recent call for
improvements to the consent process1 in partnership between the medical
profession and patients.
Andrew Coombes specialist registrar
Moorfields Eye Hospital, London EC1V 2PD
Ordan Lehmann research fellow
Department of Molecular Genetics, Institute of Ophthalmology, London EC1V
9EL
1 Goss RM. Procedure for consent still leaves much to be desired. BMJ
2000;321:111.
2 General Medical Council. Seeking patients' consent: the ethical
considerations. London: GMC, 1998.
3 Byrne DJ, Napier A, Cuschieri A. How informed is signed consent?
BMJ 1988;296:839-840.
Rapid Response:
Do patients read consent forms?
EDITOR - We measured the period of time a predominantly elderly group
of patients spent reading the surgical consent form before signing it. The
low number of patients found to read the form (1%) supports the need for
improved regulations as advocated by Goss1.
Prior to surgery, all patients must receive a simple non-technical
explanation of their intended treatment to enable them to make informed
decisions about their care2. The signed consent form documents the
patient's agreement to surgery and the doctor's affirmation that the
procedure has been explained. Since patients frequently have a limited
recollection of preoperative discussions3 and experience difficulty
reading the small typeface of consent forms4, we investigated the time
patients, who were able to read the consent form, spent doing so before
signing it.
100 consecutive patients attending a pre-admission clinic prior to
cataract extraction were assessed and received a standardised explanation
of the procedure from a single ophthalmologist. They were invited to read
and then sign the surgical consent form and the surgeon completed paper
work whilst they did so. The time they spent reading the form before
signing it was recorded to the nearest five seconds. Their near visual
acuity was measured with a near vision chart, which consists of text
printed in increasingly small typefaces5, and only patients able to read
the form (N10) (using their prescribed reading spectacles) were included
in the study.
Although all 100 patients (mean age 73 years) had sufficient near vision
to read the consent form, only one spent more than 5 seconds doing so.
This confirms the clinical impression that the majority of patients do not
read consent forms even when specifically invited to do so, reflecting
perhaps the high level of trust patients have in their doctors. Although
the time spent reading a form is not necessarily correlated with the
ability to recall its contents, cursory examination of a form that takes
over a minute to read is unlikely to facilitate long-term recollection of
the salient details. The fact that only one per cent of patients able to
read the consent form spent longer than five seconds doing so may prove to
be of importance, particularly if the outcome of treatment falls short of
a patient's expectations. We therefore endorse the recent call for
improvements to the consent process1 in partnership between the medical
profession and patients.
Andrew Coombes
specialist registrar
Moorfields Eye Hospital, London EC1V 2PD
Ordan Lehmann
research fellow
Department of Molecular Genetics, Institute of Ophthalmology, London EC1V
9EL
1 Goss RM. Procedure for consent still leaves much to be desired. BMJ
2000;321:111.
2 General Medical Council. Seeking patients' consent: the ethical
considerations. London: GMC, 1998.
3 Byrne DJ, Napier A, Cuschieri A. How informed is signed consent?
BMJ 1988;296:839-840.
4 Consent form legibility. Lehmann OJ, McLeod D, Dowling C, Carroll
RNP. BMJ 1993;306:928.
5 Law FW. Reading Types. Br J Ophthalmol 1952;36:689-690.
Competing interests: No competing interests