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Published in PLoS Medicine today, the study showed that some doctors, particularly surgeons, are not explaining the risk of specific outcomes that matter most to patients.
Overlooked risks that led to a legal claim or complaint included chronic pain, sexual dysfunction, visual or hearing loss, and the need for re-operation.
Lead author Dr Marie Bismark from the University of Melbourne School of Population Health said the study revealed that doctors may routinely underestimate the importance patients place on understanding certain risks in advance of treatment.
“Increasingly, doctors are expected to advise and empower patients to make rational choices by sharing information that may affect treatment decisions, including risks of adverse outcomes,” she said.
“However, doctors, especially surgeons, are often unsure which clinical risks they should disclose and discuss with patients before treatment and this is reflected in this study.”
The authors found that the most common justifications doctors gave for not telling patients about particular risks before treatment were that they considered such risks too rare to warrant discussion, or that the specific risk was covered by a more general risk that was discussed.
“It is not necessary, or helpful, for doctors to provide a laundry list of all possible risks. Instead, doctors should focus on discussing those risks which are likely to matter most to the patient before them,” she said.
From a sample of nearly 10,000 patient complaints and malpractice claims from Australia between 2001 and 2008, researchers identified 481 disputes involving alleged deficiencies in obtaining informed consent.
The authors found that 45 (9%) of the cases studied were disputed duty cases—that is, they involved head-to-head disagreements over whether a particular risk ought to have been disclosed before treatment.
Two-thirds of these cases involved surgical procedures, and the majority of them related to five specific outcomes that had quality of life implications for patients, including chronic pain and the need for re-operation.
Most of the other 436 claims and complaints studied involved factual disagreements between doctors and patients—arguments over who said what, and when.
“The best way to avoid this type of ‘he said/she said’ dispute is by keeping a clear record of the consent discussion that takes place before any surgical procedure, “ Dr Bismark said.
The study was conducted in collaboration with the Royal Melbourne Hospital, the National Trauma Research Institute and the Alfred, Melbourne, Harvard Law School of Public Health, Boston, USA, Avant Mutual Group Ltd and the Office of the Health Services Commissioner of Victoria