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Video Killed the Medico-Legal War
Innovation in Informed Consent Model Could save NHS Millions
London – 11th February, 2022 – An evolution in the way we focus and retain information needs to lead to a significant shake-up in the current informed consent model, today warns the UK’s sole surgical trade union. Modernising the approach could potentially save the Health Service a significant percentage of the billions spent every year in medico-legal claims.
The Confederation of British Surgery (www.cbsgb.co.uk); the only trade union to be recognised under UK law to protect the welfare of surgeons and anaesthetists; reiterates the importance of ensuring patients sufficiently absorb the information they require to make an informed decision prior to undergoing a surgical procedure. It also highlights technological advances that can make this easier on today’s overwhelmed, shorter attention spans.
According to consultant plastic surgeon and CBS President Mark Henley;
“Per the landmark Montgomery ruling in 2015, the medical profession must offer jargon-free explanations of every procedure, along with all its risks and side-effects, whether the likelihood of complications occurring is minimal or not. This process can take some time and repetition, and patients may be at risk of ‘zoning out’ as this is traditionally offered verbally in an unfamiliar environment to them (such as a hospital or clinic), alongside printed material such as leaflets. If patients don’t fully understand, or fail to remember, the risks of the procedure, they could conceivably have given consent for something that could pose dangers to their health.
“The NHS pays out billions annually for clinical negligence claims, of which the vast majority pertain to ‘failure to warn’. Just as we seek to modernise the Health Service in terms of technology, we also should bring our communication approaches into the 21st century.”
This law was established when Nadine Montgomery was awarded £5.25 million following the birth of her baby boy, who was starved of oxygen. Montgomery argued that had she been informed of all the risks of her pregnancy, she would have opted for an elective caesarean. Since this ruling, doctors and surgeons are no longer permitted to omit details of even the smallest risks when obtaining consent.
Instant gratification, such as that offered by social media videos, has clearly impacted our attention span, decreasing it by 33%[1] over recent years, and we absorb less than a fifth of verbal information and under half of all written information,[2] with time-consuming repetition being the only proven way of ensuring this information will sink in[3]. This is of particular concern in hospital and clinic settings where the risks of surgical procedures are offered in the form of verbal or written information.
Dimitris Reissis is a plastic surgery Registrar and member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). He has created the MySurgery (www.mysurgery.me) app which offers consent information via an interactive experience. He says;
“Research shows that people are far more likely to absorb information if it is offered in the form of digestible video[4] which, when applied to a medical setting, not only guarantees a higher level of crucial information retention — giving patients the tools they need to make informed decisions about their surgical procedures — but also potentially saves the NHS a percentage of the £8.3billion[5] they currently pay out for clinical negligence claims, of which 86%[6] of the surgical claims pertain to ‘failure to warn’.”
A pilot study of informed video consent in spinal surgery confirmed the potential benefits of using such a method, with 80% of patients reporting that the video consent model ‘helped to address their preoperative concerns’.[7]
Dimitris, who is also President of the Plastic Surgery Trainees Association (PLASTA) adds;
“The way patients are asked to provide consent for their treatment currently is often poorly informed and inefficient. Despite the best efforts of doctors and the medical team, patients can only retain a fraction of verbal and written information provided to them, particularly in the unfamiliar and time-pressured environment of the hospital clinic. Many patients therefore sign their consent form without having fully considered the important information that is appropriate for them in view of their own personal circumstances and personal priorities, even if this is not evident at the time.”
MySurgery one of the latest digital platforms introduced to help patients fully understand and retain information about their treatment and potential risks of their upcoming surgical procedures, and is currently in use at the Royal Free, Chelsea and Westminster, Mid and South Essex and North Central London hospitals, across specialties such as urology and hernia surgeries. Dimitris continues:
“Humans need to be able to repeatedly access information in order to retain it and, in the case of surgical procedures, must be given the opportunity to ask questions and highlight any concerns they may have. These points, along with the fears I have surrounding the impact of patients not fully understanding risks, forms the cornerstone of my work in developing the MySurgery app. We developed MySurgery after spending a lot of time speaking to and learning from patients and doctors about the most effective way to improve patient understanding and retention of information. The result is what informed consent should look like in the 21st century.”
Mark Henley concludes;
“Studies show that video is a superior way to view and retain information, and it is encouraging to learn that some hospitals have already implementing these new technologies as a means of giving patient information in a simplified way, which they can access away from the clinical setting to duly consider and ‘refresh’ their memory. In this age of bite-size information and shortened attention spans, I would urge our profession to consider optimising their approach to informed consent to ensure patients are able to understand what is often very complex, but vital, information and avoid costly medico-legal claims.”
CASE STUDY
Julie Roberts, a 59-year-old volunteer coordinator and freelance teacher from Fulham recently underwent a carpal tunnel decompression procedure at Chelsea Westminster hospital on 30th September. Julie was given information about the procedure via the MySurgery app. She says:
“I have had two carpal tunnel procedures—the first time I was given the risks and information verbally, and the second time, they used the video app. For both surgeries, it was crucial that I understood the operation and the risks involved, which meant that prior to the first, I found myself Googling and watching operations on YouTube, which is less than ideal!
“When I had the most recent procedure, I found the MySurgery app a much better alternative; it gave me the information in a digestible format and avoided the last-minute stress of feeling as though I didn’t have all the information I needed. The way it was presented was clear and concise, making it easy to process. The video model of consent feels more empowering; I felt more confident and in control of the decisions I was making.”
[1] https://time.com/3858309/attention-spans-goldfish/
[3] https://www.psychestudy.com/cognitive/memory/ebbinghaus-forgetting-curve
[4] https://www.popvideo.com/blog/looking-at-the-facts-why-video-content-has-the-highest-retention-rate
[5] https://resolution.nhs.uk/2020/07/16/nhs-resolutions-annual-report-and-accounts-2019-20/
