Bangkok Hospital Why 2 People Have To Sign 'consent' Form For Adult Operation

[fisherd3]

My friend who is 64 is having a small operation on his finger that entails a local Anaesthetic.

In a confused way the girl at the desk told him 2 people had to sign the form to authorise the operation, him being one of them.

On questioning this which the girl at the desk could not deal with, he spoke with another girl on the phone who used the word 'consent'.

Anyway he has asked me to be the second signature and not understanding why or how I could consent to a 64 Year old mans operation , I wonder if anyone knows what I might be signing ?

Thanks for any input.

[lopburi3]

Does it have something to do with insurance perhaps? I am well over that age and have never had to have anyone but myself sign anything, and yes a consent form is normal - but do not use that specific hospital.

Is your friend perhaps not able to converse in Thai or English and they want someone to confirm he understands?

[fisherd3]

Does it have something to do with insurance perhaps? I am well over that age and have never had to have anyone but myself sign anything, and yes a consent form is normal - but do not use that specific hospital.

Is your friend perhaps not able to converse in Thai or English and they want someone to confirm he understands?

Thanks for response Lopburi 3 guy is Australian I think he pays! My Thai wife says 2 people have to sign but doesn't know why! Will post later.

[HeijoshinCool]

Maybe if he dies, you pay?

[Sheryl]

The patient (or guardian if a minor/incapacitated) has to sign his/her consent and one person has to sign as witness

You signature attests to the fact that it was he who signed, nothing more

[jrtmedic]

"Desk girls" should never be involved with obtaining consent for treatment.

It is the Doctors responsibility to explain the risks/benefits of any proposed treatment/surgery. Only after a patient is satisfied with the Drs explanation should the consent form be signed by both patient and doctor !

[Sheryl]

In Thailand it is almost always administrative staff or nursing personnel who obtain the consent. The assumption being that the doctor has already provided the needed information.

One should not, of course, sign if this was not the case or before having had a satisfactory answer to all questions.

[jrtmedic]

So sorry to disagree -----it is the Drs sole responsibility --------

I accept Thailand can be and is different to the West.

BUT - In my view no one should accept signing a consent form presented by a desk girl or a nurse.

This is something which should be non-negotiable and the Dr's signature is necessary to confirm that he/she has indeed explained the risks benefits of any given procedure . Assumptions lead to errors , disappointment or worse .

Edited February 18, 2013 by jrtmedic

[Sheryl]

It is common practice in the US as well for nurses (but not admin staff) to obtain the consent form, and there is no place for Dr signature on the forms I am familiar with, either in the US or in Thailand.

Of course in the US, it's a registered nurse doing it and she actually talks with the patient to verify that s/he knows what the procedure is and has discussed it with the doctor before giving them the form to sign. In Thailand, it may indeed be a desk clerk and usually nothing is said except "sign here". ..

[jrtmedic]

I am aware that the USA has many problems associated with health care. However, I was not aware of this casual approach to obtaining informed consent. Obtaing consent involves the Dr explaining the benifits as well as the risks associated with any procedure.I find it incredulous that a Dr would delegate such a task anyone but if that is what is done and the lawyers are happy I suppose better an RN than a "desk girl" !

In the UK failure by a Dr ( or other health care professional) to personally obtain informed consent and to sign the form together with the patient would result in serious professional repercussions. Drs have been struck from the professional register for failing to obtain , personally, documented informed consent from their patient !

When I underwent surgery recently the Australian surgeon took great care to ensure that I fully understood the risks/benifits of the planned surgery. He also signed the consent form, his signature being placed immediatly below mine.

[lopburi3]

At Vejthani believe it has always been an RN staff member who obtained my (as remember the white rather than admin dress). RN work at each admin station at major hospitals, along with the admin staff.

[endure]

I am aware that the USA has many problems associated with health care. However, I was not aware of this casual approach to obtaining informed consent. Obtaing consent involves the Dr explaining the benifits as well as the risks associated with any procedure.I find it incredulous that a Dr would delegate such a task anyone but if that is what is done and the lawyers are happy I suppose better an RN than a "desk girl" !

In the UK failure by a Dr ( or other health care professional) to personally obtain informed consent and to sign the form together with the patient would result in serious professional repercussions. Drs have been struck from the professional register for failing to obtain , personally, documented informed consent from their patient !

The OP is asking about procedures at a hospital in Bangkok which is not in the UK. It might be a good idea to listen to the experience of posters like Sheryl who is vastly experienced in the practice of medicine in Thailand rather than to try to transplant your experience of medicine in a country that is half a world away.

[jrtmedic]

Last time I checked the USA is also a long way from Thailand!

Ensuring a Surgeon commits to signing a consent form ensures s/he accepts responsibility ! Such a practice can and does result in patients having a better understanding of risk as well as any claimed benefit. This is especially important in relation to cosmetic surgery.

Debate surrounding these issues is healthy and just because something is "done" does not make it necessarily right.

[endure]

So how much experience do you have working in the Thai medical system?

[Sheryl]

I am aware that the USA has many problems associated with health care. However, I was not aware of this casual approach to obtaining informed consent. Obtaing consent involves the Dr explaining the benifits as well as the risks associated with any procedure.I find it incredulous that a Dr would delegate such a task anyone

You misunderstand. Doctors in the US do not delegate the explanation and discussion. That is their responsibility and one taken very seriously. On the patient chart, they will note the discussion had with the patient and often give specific personalized details (e.g. "Mr X was informed that due to XX he is unusually high risk for complications of general anesthesia" etc etc ) which a consent form in any case would not detail. They will also note any particular concerns raised by the patient or family. Medical lawsuits are a huge problem in the US and medicine is practiced very "defensively" so this is the last thing anyone would cut corners on.

It is just that the signing of the consent form is a separate step. In the form used in the US -- and in Thailand, and I think many other countries -- the form states that the patient's physician has discussed the matter with them and explained all the associated risks, potential benefits, blah blah clearly and to the patient's satisfaction/understanding. .It DOES NOT however have a place for Dr signature and the doctor does not sign it, only the patient and a witness. The patient is confirming discussions that have already taken place, and that are already documented, in more detail, the chart. Specifically from a medico-legal standpoint the patient is at that point (right before surgery, which is when this step is done) confirming that these prior discussions were sufficient and that s/hr goes into the surgery without any unanswered questions or doubts.

There are some obvious practical reasons for this. Patients often do not make the decision immediately at the time of discussion with the doctor, they often take time to think it over, and also the exact scheduling of the surgery has to be arranged administratively etc with the result that discussion about the surgery and signing of the consent often occur on different days. In addition, the forms are very generic and do not contain the substance of the discussion (no way they could), all they do is state that a doctor patient discussion outlining risks and benefits has taken place and the patient, by signing, confirms this. I fail to see a problem with the fact that the doctor is not physically present at that point. S/he is called in if the patient indicates any confusion, doubts or questions at that stage, but this is not common as the consent is typically obtained right before surgery at which point most people have already made a firm (and yes, informed) decision.

It all seems quite normal to me, as I trained and worked in systems where it was done this way and patients were well informed. It may have struck you as odd since you came up in system that does it differently, but that does not mean it is wrong or that the underlying principle is not being observed. Administrative procedures can be arranged in many ways to achieve the same end.

[jrtmedic]

Sheryl

Many thanks for your explanation. Below I have appended a copy of an email received last evening from an English (sorry!) friend who has practised in the States as a surgeon for many years, I have redacted some of the email to protect personal information but it is otherwise intact

".Hi John

The issue of consent here is something of a hot potato. As has been indicated to you it is (was) fairly common practice for Surgeons/Physicians to delegate securing the patients signed consent for surgery and other invasive procedures to RN’s on the basis of prior explanation having occurred.

Personally I have never fallen into this potential trap and am eternally grateful for the ethical education provided to us. (It seems so long ago now ! I will be retiring in July and we hope to visit yourself and Joy possibly in September/October of this year – I will keep you posted)

Consent is(was) seen and believed to be something of a formality and often secured immediately prior to a procedure taking place.

Many now believe that such a process denies true patient involvement in the decision making process. Others claim that they fully inform their patients and make a note in the records to that effect. This practice has proven to be a profitable source of income for the lawyers! There are now said to be a number of successful litigants who have proven to the satisfaction of the courts that their Surgeon did not in fact disclose all relevant information/facts. Some have apparently claimed successfully that alteration to medical records has occurred although I only have anecdotal evidence of this.

The ACS has published guidelines related to the consenting of patients. I don't have the links immediately to hand and you may have to use my log in details to access the articles/guidelines. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

My belief is that there will be an ever accelerating move toward a system which requires Physicians/Surgeons to obtain consent from patients directly. This will be “encouraged” by the malpractice insurers many of whom now produce model procedure based consent forms which require the operators signature. You can view samples of such forms on the Doctors Company Website http://www.thedoctor...ecialty=13#list the link should take you straight to the forms. I indeed now use similar forms.

This is just a brief synopsis of the consent situation here and you will appreciate there are differences across the various States. I have not attempted to address the issues of patient competence etc. Should you require any more info please contact me and I will do my best to assist.

I hope that you and Joy continue to enjoy life and good health in your retirement paradise ! We hope to see you both soon.

Regards

Tony + Carol"

"

Edited February 19, 2013 by jrtmedic

[Suradit69]

Does it have something to do with insurance perhaps? I am well over that age and have never had to have anyone but myself sign anything, and yes a consent form is normal - but do not use that specific hospital.

Is your friend perhaps not able to converse in Thai or English and they want someone to confirm he understands?

Thanks for response Lopburi 3 guy is Australian I think he pays! My Thai wife says 2 people have to sign but doesn't know why! Will post later.

I recently had surgery under general anesthetic at Bangkok Hospital Pattaya and I was the only one who had to sign anything... and I'm well over 64. Sounds a bit odd.

Edited February 24, 2013 by Suradit69

[Sheryl]

They won't make you get someone else in just to witness, if you are by yourself one of the hospital staff will sign as witness. But if a friend or family members is present most hospitals will usually prefer that they witness since they are obviously in a better position to attest both to your identity and soundness of mind.