Inadequate Consent for Circumcision Procedure

Inadequate Consent for Circumcision Procedure

Setting the Scene

The patient attended the Trust after suffering from a swollen and painful penis for an extended period of time. The Trust advised that the Claimant undergo a circumcision (surgical removal of the foreskin) in order to address the issue of pain. The patient was given leaflets which outlined this procedure and the risks associated with the same, however no discussion took place between the patient and the clinician about these risks.

The main learning points from this review stem from the following events:

  1. When the clinician provided the patient with the leaflets about the procedure, he did not actually discuss the risks addressed in the leaflets with the patient.

  2. The clinician did not discuss the risk of dissatisfaction with cosmetic appearance with the patient before he underwent the procedure.

Recommendations to Prevent Incident Recurrence and Improve Patient Safety

TMLEP’s recommendations to reduce recurrence and enhance patient safety are as follows:

1. In a post-Montgomery world, Clinicians need to ensure that they discuss all material risks with a patient when consenting them for a procedure.

Prior to Montgomery, it could be seen as acceptable to simply give a patient a leaflet which outlined the risks of the procedure that they were being consented for. However, in light of Montgomery, it is now important that clinicians discuss all material risks (i.e. risks that a similar person in that particular patient’s position would attach significance to) with the patient as part of the consent process. The risks need to be carefully explained to the patient in a way that they can understand; as a layperson with no medical knowledge and alternative treatment options should also be mentioned. Leaflets are still a good source of information; however, clinicians should go through the information contained in these with the patient and anything else that is relevant and document this process in their records.

2. Clinicians should consider carefully the risks a patient will likely attach significance to and should make sure that these are brought to the patient’s attention as part of the consent process.

When consenting a patient for a procedure, the clinician should consider which risks the particular patient would attach significance to, and should then discuss these with the patient, as part of the consent process. The clinician should consider what that individual patient, given their characteristics, would consider relevant. Factors to consider are: the nature of the risk, its effect upon the life of the patient if it occurred, how important the benefits of the treatment would be to the patient, the alternatives available, and the risks involved in those alternatives. For example, since in this particular case there was a significant risk of a poor cosmetic outcome, this should have been discussed with the Claimant, as well as any alternative treatments that could be offered.

To Summarise

It is of vital importance that a discussion of the risks involved with a procedure takes place between the patient and the clinician as part of the consent process. Clinicians should document this discussion in the patient’s records.

References

  • Co-written by The TMLEP Clinical Risk and Patient Safety Publishing Group, Mr Christopher Dawson - Consultant Urologist BSc MS FRCS LLDip (2019). A Clinical Risk Case Study-Inadequate Consent for Circumcision Procedure. TMLEP Clinical Risk Case Studies. 2 (10), 1.
  • Montgomery v Lanarkshire Health Board [2015] UKSC 11

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.