Core Concepts

Consent Related Error

Medical Error has been defined as “failed processes that are clearly linked to adverse outcomes” (AMA – Hofer et al. 2000). Typically, when we think of medical errors, our minds turn to medical procedures. However, if we consider that informed consent is a process, and then when not done properly, adverse outcomes are likely to ensue – then there are a whole category of medical errors that we have not been paying much attention to. Consent related errors refer to any element of informed consent being done inappropriately. Inappropriate may refer to expectations of consent related elements (e.g. test for capacity) where no such element is required, or it may refer to misinterpretation of a consent related element (e.g. interpreting a patient value to constitute a prior expressed wish). Most distressing are consent related items that are simply ignored (e.g. obtaining consent from the wrong person). It is because there are so many ways in which consent can be erroneously applied to a patient, that we have created the HCQC.

Evidence Informed – Values Driven




Patient-Centred Pragmatism

Patient-centredness has long been touted as a fundamental goal of modern healthcare – but for just as long there has been contention around what is meant by the term. We believe there is a fundamental respect for patient values, wishes, and beliefs that form the foundation of patient-centredness, but stop short of implying that patient wishes are somehow determinative. Patient-centred pragmatism, recognizes the fundamental responsibilities both clinicians and patients have in the consent process, and in particular that it is physicians who generally propose treatments and treatment plans. The implication is that patients (and their substitute decision-makers where patients are incapable) are only able to consent to treatments that have been proposed. While concerns have been raised that this approach allows a physician’s personal value judgments to interfere with patient self-determination, we believe these are based in a misunderstanding of physicians’ responsibilities to offer all treatments that reasonably fall within the standard of care, or are indicated.