Informed Consent: Good practice solutions to common clinical scenarios

That would be preferable if there is a reasonable likelihood of such complications after noting the patients previous medical/surgical history and/or is a commonly known complication. If that detail was contemporaneously documented, it would certainly be of invaluable assistance in the defence against any allegations that an informed consent did not occur.

No. There is no difference in the legal and/or regulatory expectations concerning consent for private and public patients. Legally, regulatory and ethically there should be no difference in the standard of any healthcare delivery irrespective of the billing or funding arrangement.

Practitioners are entitled to be directors of companies such as Finance companies. The concern here was cross promotion, a conflict of interests as well as the referral in such circumstances being seen as an endorsement of the surgeon concerned. This would be found to be unprofessional conduct by regulators.

Knowingly not obtaining the consent as required by a court order may be contempt of court. There may be a fine or worse and even a referral by the courts to AHPRA concerning such unprofessional conduct. Only in the case of emergency treatment should treatment proceed without consent.

A contemporaneous documentation in the patient’s record will be very valuable especially in circumstances where matters are considered after a lengthy period post the event. That is, you are not simply relying on your memory or your usual practice, you have evidence. Best practice is to have the consent in writing from the patient. Ultimately it will up to the court or tribunal to consider and weigh up the evidence it considers credible.

The person who can consent on a patient’s behalf is as follows:

If the person is an adult; in hierarchical order:

1. A person appointed under legislation as the persons medical treatment decision maker, guardian, medical power of attorney or similar:
2. the spouseor domestic partner of the person;
3. the primary carerof the person;
4. the first of the following and, if more than one person fits the description in the subparagraph, the oldest of those persons;

(i) an adult child of the person;

(ii) a parent of the person;

(iii) an adult sibling of the person.

 If the person is a chid the relevant person is the child’s parent or guardian or other person with parental responsibility for the child 

In the case of emergency treatment no such consent is required.

Yes, they still do apply although the nomenclature varies from state to state. They are documents where you (the donor) appoint someone (the agent) to make medical treatment decisions for you like agreeing to medication or surgery in the event you are unable to or lose the capacity to consent.

Yes, it is. Best practice would be to obtain the patients written consent after a discussion of all the material risks, next best would be a contemporaneous note in the patient’s records.

There are two possibilities when a patient makes such a request. If it makes you uncomfortable, you have the option to decline the recording. Should you be suspicious of a patient's intentions or if you believe the professional relationship has been compromised, another option might be to terminate the patient-doctor relationship. Naturally, you should facilitate continuity of care. Termination may not be appropriate where urgent treatment is required and/or the patient is at risk of any harm. 

A recording may be viewed as an excellent resource and evidence of your appropriate professional conduct, accepted level of clinical care, behaviour, consent etc. and therefore, stymieing any complaint or allegation of sub optimal care. It may also be used by the patient to better understand the health issues at hand or the management plan you propose. Perhaps you may agree to the consultation being recorded on the basis you are provided with a copy of the recording and include this in the patient record. It should be noted that all electronic communications such as texts, emails and recordings would form part of the patient’s record. As members would be aware any detailed record keeping is a valuable asset in defence of any complaint, claim or investigation against you.

There is specific State/Territory legislation relating to audio recordings of private conversations and whether consent of all parties is required. In all jurisdictions except Victoria, Queensland and Northern Territory, it is illegal for patients to record your consultation without your permission and members with concerns could advise their patients of this.

This is likely to be viewed in an unfavourable light by the regulator, generally the consumer authorities and by the community as the health service has not yet been provided. On the other hand, the anaesthetist may have experienced previous billing problems with the patient.