Obtaining valid consent
Useful member guidance on obtaining valid consent before examining a patient
When carrying out an eye examination, practitioners must obtain the patient’s agreement for the procedures and treatments they intend to carry out. It’s critical that the patient has been properly informed, understands the impact of the decisions they are making, and has appropriate mental capacity to reach these decisions. This guidance is designed to refresh practitioners' knowledge on GOC standards, when to explicitly ask for consent and what to record.
Explicit or implicit
Consent can be given implicitly or explicitly. If a patient attends an appointment for a sight test, you don’t need to ask whether they consent to you examining their eyes, because the act of attending the appointment is a form of implied consent. Likewise, if you’re examining a patient’s eyes and they lean forward to put their chin on the slit lamp’s chin rest, it’s reasonable to assume they have given implied consent for the slit-lamp examination.
Explicit consent is when the patient gives their permission for you to do something specifically, and this permission can be oral or written. Explicit consent is important for procedures which are more invasive or carry a greater risk. We recommend obtaining explicit consent for procedures which are more invasive, such as applanation tonometry, instilling dilating drops or staining agents, and fitting contact lenses. Whether you need explicit consent depends on what procedure you are performing, but it’s sensible to ask for this kind of consent where something may touch the eye. If you’re referring a patient, it’s important to check that the patient has consented to the referral, although it’s also worth noting that the The Information Governance Review1 confirmed that implied consent was sufficient for data sharing amongst medical professionals, so the receiving clinician should not need fresh consent to send feedback following the referral.
GOC standards
The GOC Standards of Practice2 state that you should:
3.1 Obtain valid consent before examining a patient, providing treatment or involving patients in teaching and research activities.
3.2 Be aware of your legal obligations in relation to consent, including the differences in the provision of consent for children, young people and vulnerable adults.
3.3 Ensure that the patient’s consent remains valid at each stage of the examination or treatment and during any research in which they are participating.
8.2.6 Record consent obtained for any examination or treatment.
The College of Optometrists advises that optometrists should use their professional judgement to determine what type of consent is needed and how to record this.
Recording consent
Consent can be given in written form and also verbally. Implicit consent does not need to be recorded, but it is advisable to record that consent has been given for more invasive tests and those which may incur an additional charge to the patient. This can be recorded in the form of a tick box on a record card or by a simple comment ‘VCG’ ( ‘verbal consent given’).
In some cases where a treatment is more complex or risky, written consent should be obtained. This can be in the form of a consent form, which is commonplace for treatments such as myopia management.
You should also record when consent has been refused or withdrawn.
Capacity
Patients with cognitive impairment may not have the mental capacity to give consent. The AOP has published guidance on Obtaining consent from patients with dementia to help practitioners navigate these situations.
Avoiding complaints
At the AOP, we often see complaints where a patient has undergone an additional test such as OCT but has then claimed that they weren’t advised of the charge ie they hadn’t made an informed decision. Where a procedure may incur an additional charge, it is important that this is explained clearly beforehand, and we recommend recording whether the patient has consented.
Further information
If you would like further information on this topic, please review our guidance on Informed consent. If you have a specific query, please get in touch with our clinical and regulatory team at [email protected].
References