The Operating Theatre Journal March 2022

VIDEO KILLED THE MEDICO-LEGAL WAR
Innovation in Informed Consent Model Could save NHS Millions
An evolution in the way we focus
and retain information needs
to lead to a significant shakeup
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 sideeffects,
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 timepressured
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 bitesize
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/
[2]https://www.mysurgery.me/
[3]https://www.psychestudy.com/
cognitive/memory/ebbinghausforgetting-curve
[4]https://www.popvideo.com/blog/
looking-at-the-facts-why-videocontent-has-the-highest-retentionrate
[5]https://resolution.nhs.
uk/2020/07/16/nhsresolutions-annual-report-andaccounts-2019-20/
[6] https://core.ac.uk/download/
pdf/82628201.pdf
{$NOTE_LABEL} https://bmjopen.bmj.
com/content/9/7/e027712
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