Informed consent

The scenario

Martin, AOP member

“I qualified as an optometrist almost 25 years ago. Following a discussion with colleagues in practice recently, I revisited the GOC’s guidance on informed consent that was updated a couple of years ago in order to better understand what is required of me as an optometrist. I was particularly interested in learning more about providing patients with correct and sufficient information, as well as when I may require verbal or written informed consent. There is a lot of information available online and, at times, I found the requirements confusing. Could you explain the importance of informed consent in practice since the guidance was updated and when and how a practitioner could find themselves falling short on its requirements”

The advice

Katie Elford, AOP paralegal

Why is consent important?

An effective relationship between an optometrist and their patient must be based on partnership and trust. In order to maintain patient trust, decisions relating to examination and treatment should be made on a joint basis. This allows the patient to make an active contribution to their treatment and will lessen their dissatisfaction in the event of any adverse outcome because they will have been made aware of the risk of this outcome and agreed to it.

Obtaining valid consent

Valid consent can be given by an adult patient easily, be it orally, in writing, or by implying the same. For patients that lack capacity (that is because of their age, mental disability and so on), consent can be given on their behalf, for example, a parent consenting for a child.

In order to maintain patient trust, decisions relating to examination and treatment should be made on a joint basis

Providing correct and sufficient information

There is a duty to take reasonable care to ensure that the patient is aware of any ‘material risks’ involved in any recommended treatment, and of any reasonable alternative or variant treatments.

A material risk is, in the circumstances of the particular case, a risk that a reasonable person in the patient’s position would be likely to attach significance to, or the optometrist is or should reasonably be aware that the particular patient would be likely to attach significance to. A question to ask yourself is: ‘If this risk materialised, would the patient feel justifiably aggrieved to not have been informed of it?’

What is required and when?

Patients can give consent orally, in writing, or may imply consent by their behaviour. You should use your professional judgement to decide what type of consent is required.

In non-invasive procedures such as visual fields tests, the patient resting their chin on the chin rest would normally be sufficient for implied consent, particularly if it is a test that they have undergone before. Furthermore, by booking an eye examination, it would normally be considered that the patient has given their implied consent to all the tests involved in a routine examination.

However, for more invasive or intrusive procedures, such as instilling dilating drops, explicit verbal or written consent is required. Generally speaking, the greater the risk of something going wrong, the greater the importance of making sure you have clear consent.

You must also make sure that you inform the patient of any risks or alternative treatments in language that they can understand in order for the consent to be fully informed.

Patients can give consent orally, in writing, or may imply consent by their behaviour. You should use your professional judgement to decide what type of consent is required

Where could you face issues?

Firstly, it is vitally important that any discussion of risks and verbal consent be specifically included in the medical record. A clinical negligence claim can be started within three years of the claimant suffering an injury as a result of their treatment or becoming aware of an injury. By this time, most optometrists will have seen thousands of other patients and will therefore be relying on the information in the record as their defence. A poor record leads to a poor defensive position. If the patient is alleging that they were not made aware of a risk or were not informed of alternative treatments, a detailed record showing that they were indeed informed is far more protective than an optometrist’s word against the patient’s.

Secondly, you should ensure that if you do begin to advise a patient as to risks, you inform them of all material risks in order not to fall short of providing sufficient information and do not cherry-pick the information based on what you believe is the best course of action.

Lastly, in the event that you are advising a patient who is looking to undergo ophthalmic surgery, you should emphasise to the patient that the final duty to obtain their consent and inform them of the risks lies with their ophthalmic surgeon. You do not want to fall foul of a patient’s ire if their surgeon has omitted a material risk where you yourself have advised them as to the risks because they may look to pursue you too.

Image credit: Getty/RapidEye