Ensuring Compliance with Digital Signature Lawfulness for Physical Exam Consent in United Kingdom

How to eSign a document: digital signature lawfulness for Physical Exam Consent in United Kingdom

Hello, my name's Ed Nandasoma. I'm one of the team  of medico legal advisors at the MDU and this is a   short video to introduce the GMC's new guidance on  decision making and consent. The guidance becomes   live on 9 November and I've included a link in the  description so you can access it on the relevant   section of the GMC's website. The guidance is  relevant to all doctors though those of you   treating patients under the age of 18 should read  it in conjunction with the GMC's 0-18 guidance.   I know you'll be really busy right now and I'll  try and take you through this guidance as briefly   as possible but I do want to talk very briefly  about the context in which this guidance has been   developed. What test should be applied to judge  whether adequate consent is in place has been a   matter of debate for many many years. Should it  be a matter of medical judgment alone? Should   it be with reference to what a reasonable patient  undergoing a medical intervention might think? Or   should it be with reference to the characteristics  of a particular patient undergoing the procedure   or essentially the patient in front of you?  Up until 2015, the legal test was very much a   medical one. In simple terms, a doctor would not  be judged negligent in their approach to consent   if they'd follow the practice of a  reasonable body of medical opinion   so essentially consent also fell under the  the Bolam test. However when the GMC last   updated its consent guidance in 2008, it placed  quite specific and rigorous duties on doctors   to share information in the patient centred  way, focusing on a duty to share information   that a patient may need or wish  to know about their treatment.   In 2015, the legal test also evolved to become  much more patient centred. I've not got time   to go into the details of that case but many of  you will have heard of it the Montgomery judgment   and I include links in the description again  to some relevant articles on the MDU's website.   The GMC's new guidance is really an evolution   of its past guidance to really take into  account those developments since 2008.   The guidance takes a principles based approach  and I've set those out over the next few slides.   You'll not be surprised that the emphasis is  on involving patients in decision making and   supporting all patients including those who might  have factors that could compromise their ability   to make decisions in engaging with the consent  process. You'll see that there's also an emphasis   on trying to find out what matters to an  individual patient and again an emphasis on fully   talking about reasonable alternatives  including the option of taking no action. The guidance also deals with how to approach  patients who lack capacity and again that's   based on the Mental Capacity Act and is not  surprising we're required to involve those   with an interest in the patient's care or those  close to them in decision making. And there's also   a reference to involved patients even where their  right to consent is affected by law for example   those patients having compulsory treatment.  Now the guidance does go into some detail about   how we can apply these principles. There  is reference to a proportionate approach   so I think the idea here is that the amount  of time the amount of information exchanged   in a consent discussion will really depend on the  complexity and the consequences of the treatment.   There is some acknowledgement that urgency of  treatment may limit the extent of a discussion,   though it's still expected that will involve all  patients who are conscious in decision making   wherever possible. There is also some direction  on what information is relevant. That's largely   based on on the the principle set out in the 2008  guidance. And there's also some reflection on how   to apply this guidance to the legal principles  which have been updated since Montgomery.   Now there is certainly food for thought in  this guidance. There's an express statement   that a signature on a consent form on its own is  no substitute for a meaningful discussion with   a patient. That's not to say the consent form  is of no use or it's not important. Of course,   understand it is in the context of patient safety  and checklists. It's rather to say that our record   should reflect more than the content of most  consent forms and evidence that we've had relevant   discussions, listened to the patient's concerns  and priorities and shared relevant information and   also been clear about the scope of any decisions  made. The guidance also encourages doctors to   consider advanced care planning where that's  relevant where a patient might be anticipated   to have a progressive condition that could impair  their ability to engage with decision making in   the future and it also talks about providing  objective information on risks wherever possible   and also acknowledging uncertainty where there are  uncertainties that that can't really be resolved   and where the risks and benefits may need  to be reevaluated as treatment progresses.   There are some helpful acknowledgements in this  guidance. I know many of us will be thinking   about how we can implement this guidance  most effectively when we're faced with the   pressures on services as they are currently.  I'd emphasise again there's a discussion on   a proportionate approach, meaning the  the amount of time we devote to consent   is proportionate to the consequences  and the complexity of treatment.   There is an acknowledgement that resource  constraints impact on our ability to follow   the guidance and it talks about about our duties  to raise concerns if that is impacting on   services. There is also an acknowledgement  of multi-disciplinary working and delegation. Essentially it's acknowledged that other  members of the multidisciplinary team may   play a key role in sharing information as part  of providing the patient with information and   be a really important part of the consent  process. It's also acknowledged that   there may be some circumstances where if  you've got someone who is properly trained   and able to have these discussions, that it's  perfectly appropriate to delegate the consent   to that practitioner. However the GMC still  maintain that position that if we're the doctor   providing treatment it's up to us to be satisfied  that proper consent is in place before proceeding.   Finally the GMC talk about how they'll use this  guidance in their fitness to practice procedures.   They explain that they're only likely to be  engaging doctors in their procedures when   there is a serious or persistent  failure to follow this guidance.   Now of course, those sorts of issues often  come up many years after a patient was treated   and frankly only time will tell how this will  will be used in the regulation of doctors.   So I hope that was helpful. I know that you've  got a lot to keep abreast of at the moment but   this is a revision of one of the GMC's core pieces  of guidance that hasn't been updated for some time   so I'd encourage you to spend a few minutes  on the GMC website reviewing it for yourself.   We will also be hosting a webinar on consent that  will hopefully allow us to go into this guidance   and other issues surrounding consent in a lot  more detail, so please do look out for that.   So thank you very much for watching. I hope  that's helpful. Thank you for your attention.