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What does good consent look like in practice, and what are the patient safety consequences when patients are not truly informed? Join Radar Healthcare's webinar, Digital consent: How to deliver safer outcomes by bringing consent, risk and insight together, to explore the vital link between patient education, informed decision-making and safer care. Featuring perspectives from the Patients Association, Patient Information Forum, legal experts and frontline clinicians, this CPD-certified session will examine how organisations can strengthen consent processes, reduce risk and improve patient outcomes through better communication, education and insight. Register

Julie Smith is a content director for a patient information library, and a Topic leader for the hub. In this blog she draws on recent research and her own expertise to explain why deprioritising patient education represents a failure to keep patients safe. Patient education and surgical outcomes: what the evidence shows Last year, Caroline Kamau-Mitchell published her research findings for The Surgeon titled ‘Benefits of patient education in surgery’ [1]. Her work involved surveying 38,689 patients who underwent a procedure in the NHS in England. Kamau-Mitchell found that around half of patients felt anxious before their procedure and this often correlated with outcomes, both in terms of patient satisfaction, but also post-procedure results. She noted that patient education: can reduce preoperative anxiety increases satisfaction teaches people what to expect from surgery and when to seek help. When patient education is rushed, safety is compromised I am the content director for a patient information library so it’s no surprise that this paper piqued my interest. It is both reassuring and affirming to see in black and white just how much of a difference good patient education makes. Sadly, we do hear both from patients and clinicians that information sharing is sometimes limited and rushed. In order for the patient to be truly educated and informed, they need time to digest the information, mull it over, discuss with loved ones, before deciding. Unfortunately, this is not always the case. Healthcare providers are busy, overwhelmed and under pressure to deliver against tight targets and deadlines. This can result in cutting corners such as rushed consultations, very little time between information sharing and the procedure itself, and ultimately, unsafe care. The result of this could be catastrophic; symptoms of a serious complication may be ignored, important post-operative advice may be missed and, ultimately, the consent given will not be truly informed. Anxiety, uncertainty and the patient experience of surgery The point around anxiety is also an important one to consider. Hospitals may be second homes to our healthcare providers, but to most people they are overwhelming, alien and can carry negative connotations or memories. There are strange smells and sounds, people walking around in scrubs and masks, not to mention the maze-like configuration of so many of them. This is all before you consider that the patient may have a life-threatening condition, an awful injury or unexplained symptoms that require a procedure. If we have an opportunity to reduce their anxiety, especially given Kamau-Mitchell’s conclusion that this can be reduced with patient education, we absolutely have to take it. Patient education is a core component of safe care Kamau-Mitchell’s research shows that we cannot afford to cut corners when it comes to patient education. Deprioritising patient education represents a failure to keep patients safe. The evidence is there for all to see; properly educated patients are more satisfied, less anxious, have better outcomes and know what the warning signs are if anything goes wrong. We want to make patients feel safe when they have surgery. This isn’t just about having the right person with the right expertise providing their care, it’s also about them being prepared and knowing what to expect. Patient education plays such an important part in this and so it is our duty to both get it right in terms of its content but also make sure it’s shared in a timely and accessible manner. Making consent a meaningful process, not a formality Accountability is key here – consent must be treated as a defined and prioritised part of the care pathway, supported by leadership and embedded in organisational processes. There is plenty of good-quality information and well-informed healthcare professionals able to deliver the information but if they are not given the time and resources to deliver it, the issue of poor consenting processes will persist. It is the duty of clinical and safety leadership to ensure good patient education is prioritised and promoted so it becomes a part of the culture of their organisation. Failing to prioritise patient education is a preventable patient safety risk and should be treated as such. Kamau-Mitchell’s study findings must be considered by any healthcare providers when it comes to how they much time and effort they put into providing education for their patients. If they don’t, they put their patients at risk of poor experience, poor outcomes and uninformed consent. Reference [1] C. Kamau-Mitchell, “Benefits of patient education in surgery,” The Surgeon, pp. 162-166, 2025.

This innovative educational initiative was developed as a direct and constructive response to the communication inadequacies exposed by the Montgomery case, and subsequent legislation. While it is not difficult to give "more information" it is harder for surgeons and patients to achieve a decision partnership. The ICONS workshop content has been informed by internationally recognised experts in Shared Decision Making, by consensus among senior practising surgeons, by patients and by professional experts in risk management and risk communication. Delegates on the ICONS workshops will acquire skills and knowledge to implement best practice in sharing the complex decisions surrounding informed consent. By participating in a workshop, they will also contribute to the development of resources for future training in the important area of informed consent. Target audience All grades of trainees; SAS / LED / Trust Doctors; Consultants. Non FRCS surgeons – Ophthalmologists; Obstetricians and Gynaecologists. Learning style Focussed topic introductory talks. Small group facilitated discussion tutorials based on review of exemplar videos of consent and other patient doctor communication scenarios. Aims & objectives The objectives of the course include: Learn the potential catastrophic and costly consequences of failure adequately to share important surgical decisions. Recognise the importance of discussion treatment options rather than risks. Understand key features of the case Montgomery v LHB 2015. Appreciate the legal view of Shared Decision Making. Identify key elements of a Shared Decision Making consultation. Understand how to deliver treatment recommendations. Gain new consultation skills. Identify and apply effective ways of risk communication. Appreciate the role of decision support tools before, during and after the clinical encounter. Understand the added value of writing letters directly to patients. Learning outcomes Having attended the ICONS workshop you will be able to: Understand the practical importance of the Montgomery decision. Identify the key elements of a Shared Decision Making consultation. Discuss options including surgery – elective and emergency. Employ efficient methods of eliciting patient needs, preferences and values in a busy clinic. Understand the added value of patient activation before options are discussed, and decision distribution thereafter. Develop skills for well-balanced, meaningful surgeon patient interactions. Communicate risk to patients in a more realistic way. Appreciate the role of recommendation. Review the limitations of and variation in current consent forms. Register

Julie Smith is a Patient Information Topic leader for the hub, a consent expert, and Content Director at EIDO Healthcare. In this two-minute video, Julie shares five things you should know about consent, focusing on: accessible information your options time additional consents changing your mind.

Dan Cohen is an international consultant in patient safety and clinical risk management, and a Trustee for Patient Safety Learning. In this blog, Dan discusses the four principles of medical ethics, specifically focusing on how each applies to providing safe patient care. Our moral imperative Having spent more than 50 years as a doctor, I have come to appreciate that everything in my, and our, professional life comes back to the basics of why we entered the healthcare professions in the first place. We genuinely wanted to help people, to keep them healthy and to return them to their maximum healthy state when they became ill. We wanted to serve our patients by being helpful. This has been our moral imperative and our beacon. This moral imperative is the reason we get up every day and go about our jobs, often working under stressful circumstances confounded by environmental stressors, liabilities related to human factors and process inefficiencies. All of these factors have an impact on our effectiveness in clinical settings, with stress and burnout also trickling over into our personal lives. Providing healthcare is challenging, especially when so much of our work environment is seemingly out of our control. Yet we keep coming back for more because we really care. Healthcare professionals may be viewed as special and unique people by many in society, sometimes even put on a pedestal. But really, they are mostly ordinary women and men, drawn by an important calling with highly specific and serious responsibilities. What we do is special and unique! Healthcare professionals try to provide the highest quality care, focusing on optimal clinical outcomes while avoiding mistakes, errors and harm to patients. We also acknowledge that what matters most to patients influences our approach to their care. How we satisfy our moral imperative is governed substantially by adhering to the medical ethics; i.e., the behaviours, actions and deeds that are held within the moral imperative. Behaviours that do not align with the moral imperative are considered unethical. The principles of medical ethics The principles of medical ethics have been best characterised by four foundational pillars, first elucidated by Tom L. Beauchamp and James F. Childress in 1979 in their seminal book, Principles of Biomedical Ethics.[1] These principles remain as relevant today as they were when first described. I will discuss briefly these foundational pillars, specifically focusing on how each applies to providing safe patient care. Principle 1: Respect for patient autonomy Providing healthcare should be a collaborative process with professionals and patients working together to achieve the best outcomes. Therefore, patients’ needs, wants and expectations should be foremost. Optimal outcomes, especially in outpatient care, cannot be achieved without patient engagement, as the patients are generally the implementers of care, certainly after they leave their doctors’ surgeries. Patients are entitled to be informed about the risks and benefits of interventions that may cause them harm, surgical interventions most notably, and this requires discussions and sharing of information to ensure patients are appropriately involved in decision making. The practice of obtaining signed patient consent for surgical procedures acknowledges this. However, consent is often obtained in a 'slap-dash' way by having patients sign forms that may be incomplete or incompletely understood by patients. The informed consent process, as it has been operationalised, may satisfy legal requirements but is often flawed as it may not generally include a thoughtful doctor to patient discussion of risks and benefits. Respect for patient autonomy absolutely requires adherence to the principle of candour in healthcare. If mistakes are made in providing care, patients deserve to have these mistakes discussed with them in a timely fashion. This generally means shortly after the mistake has been discovered and is especially crucial with mistakes that have caused harm or may cause delayed harm. Until patients release us from our responsibilities as their care provider, we must remain committed to satisfying their healthcare needs. This cannot be accomplished if we are not honest and candid when discussing what has happened. There is now good evidence that candid discussions decrease the frequency of medical negligence claims and lawsuits and the size of healthcare injury claims paid.[2] [3] Caring for patients means respecting them and sharing information with them, whether that's for the better or worse. Principle 2: Beneficence Healthcare professionals are required to provide care that is intended to be beneficial to patients. It may seem counterintuitive to say this, but what this really means is that the care provided should be evidence-based and comply with the highest standards designed to achieve best outcomes. There are certainly instances where evidence is lacking or controversial or where doctors and/or professional groups may disagree regarding the best care and how to achieve best outcomes. Yet each healthcare professional must aspire to provide the best possible care, even in the face of uncertainty. And if there is uncertainty, then that uncertainty also should be discussed with our patients. This principle requires that healthcare professionals be willing to discuss "alternative approaches" to standard healthcare therapeutics if patients bring these options into the discussion, including the use of acupuncture, homeopathic and/or herbal products, and other approaches that patients may wish to consider. After all, patient autonomy must be respected, so professionals, regardless of their own opinions regarding these interventions, must be willing to listen and provide relevant information in a compassionate way. It is important to point out to patients when some of these alternative approaches may be harmful in certain situations. For example, certain herbal treatments may pose risks for patients taking oral anticoagulants. Healthcare professionals must share their concerns about what risks are known and mention when risks are not known. I have come across this dilemma in my own practice and I would be honest and say something like: “I cannot say with confidence that what you wish to do will be safe or unsafe, because I simply do not know the answer, although I will look into this more thoroughly. However, if I cannot find evidence of safety, then I cannot fully support you using 'XYZ' because I will be concerned that it may be harmful. The choice is always yours, and I respect your decision even if it is not one that I would make myself". Principle 3: Nonmaleficence This principle, which some have interpreted simply as "do no harm" is actually more complex than that. By their very nature, some of our recommendations cannot always avoid harm. So, by extension "do no harm” really means to avoid unnecessary harm to the extent that this is possible. For example, for a patient undergoing surgery, the surgeon will use a scalpel to perform the surgery. Hence the surgeon must actually harm the patient in order to perform the surgery, and that harm could lead to further harm (e.g., bleeding, infection, etc.) that was never the intention of the intervention. In the same way, chemotherapy to treat cancer may carry substantial risks of harm because of medication side effects that cannot always be avoided. This is the reason that informed consent must address the risks and benefits of the treatment, and professionals must make sure their patients fully understand these risks and benefits. Nonmaleficence means to avoid unnecessary harm whenever possible. Principle 4: Justice Sadly, even in our caring professions, not all of our patients are treated fairly and equitably. The principle of justice requires that all patients be treated without reference to their genetic, biological, social and economic backgrounds, gender or gender identity, and political views. The impacts of prejudices and biases against individuals of differing ethnicities, skin colours, social classes, political views, and coincidental health and lifestyle issues have adversely influenced both access to healthcare services and the quality and timeliness of healthcare services provided, possibly resulting in adverse healthcare outcomes.[4] [5] [6] For example, individuals with obesity and smoking related comorbidities and illnesses are often viewed as "responsible" for their health challenges and subject to biases, whereas recreational middle distance runners are rarely viewed negatively for their anterior cruciate ligament (ACL) injuries or joint osteoarthritis. Healthcare professionals thus have a moral obligation to acknowledge this vulnerability in themselves and to never let these biases or prejudices interfere with our provision of care. Our prejudices may well harm patients and/or prevent them from achieving optimal healthcare outcomes. This is particularly an issue when professionals are working under stress and task saturation, when we tend to take shortcuts in diagnosis and may rush to solutions or be less sympathetic and compassionate to those who are "not like us". Disparities in care are dangerous variables when providing safe, high-quality healthcare for everyone. Summary The principles of biomedical ethics apply directly to the fundamental moral imperative to provide the highest quality care while avoiding mistakes, errors and harm to patients. We must ensure that what matters most to patients influences our approach to their care and, thus, to adherence to this moral imperative. The foundational pillars of medical ethics also require professionals to be honest with patients when things go wrong and to focus on sustaining the relationships between patients and their care providers. Therefore, healthcare professionals are advised that before walking into their clinics, surgeries, hospitals, etc., they should stop and pause momentarily to reflect upon who they are as professionals, the moral imperative they work under and the professional behaviours that must align with the moral imperative. We must recognise the challenges of working in a complex environment and be especially careful. Stress degrades behaviour for all of us and, from time to time, I have been as much at fault as anyone. It’s called being human. Be part of the solution, not part of the problem. References Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 8th Ed. Oxford University Press, USA, 2019. Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine 2010; 153(4): 213–21. Kachalia A, Sands K, Van Niel M, et al. Effects Of A Communication-And-Resolution Program On Hospitals’ Malpractice Claims And Costs. Health Affairs 2018; 32(11): 1836–44. Lavizzo-Mourey RJ, Besser RE, Williams DR. A Half-Century of Progress in Health: The National Academy of Medicine at 50: Understanding and Mitigating Health Inequities — Past, Current, and Future Directions. N Engl J Med 2021; 384:1681–4. Sabin JA. Tackling Implicit Bias in Health Care. N Engl J Med 2022; 387:105–7. Fernandez A, Chin MH. Keep Your Eyes on the Prize – Focusing on Health Care Equity. N Engl J Med 2024; 390:1733–6. Further reading on the hub from Dan: Clarity and the Art of Communication for Patient Safety Late night reflections on patient safety: commentaries from the frontline (2014) Diagnostic errors and delays: why quality investigations are key Patient Safety Spotlight Interview with Dr Dan Cohen, Patient Safety Learning Trustee Structures, processes and outcomes for better or worse: Personal responsibility in patient safe care What does all this safety stuff have to do with me? How one professional’s arrogance led to new insights Interview with Dr Dan Cohen on human performance

The 2024 EIDO conference, ‘The Consent Conundrum: Legal Insights and Practical Solutions’, explores medical consent through various lenses. Taking place on Tuesday 26 November at the East Midlands Airport Raddison Blu Hotel, this FREE event is open to surgeons, consultant nurses, legal service managers and anyone with an interest in shared decision making and informed consent. Reasons to attend the EIDO conference: Get FREE access to EIDO’s CPD-certified e-learning course The Legal Aspects of Informed Consent: Foundation Course after the event Gain insight into medical negligence, international perspectives on consent, and collaboration in patient information. Listen to expert speakers discuss digital transformation in patient care, system interoperability and consent issues in recent inquiry reports. Earn CPD points and receive a CPDUK certificate after the event. Register for the conference

EIDO Healthcare’s upcoming in-person conference on 26th November will focus on how improving informed consent practices can directly enhance patient safety. The event is organised by Julie Smith, EIDO’s Content Director and a topic lead for Patient Safety Learning's hub. ‘The Consent Conundrum: Legal Insights and Practical Solutions’ will explore how medicolegal expertise and practical approaches to informed consent can prevent medical negligence and improve patient outcomes. Discussions will include case studies highlighting patient experiences, the latest updates on consent, and the crucial link between informed consent and patient safety. Speakers include: Simon Hammond, Director of Claims at NHS Resolution Mr Parv Sains, Medicolegal Lead for RCS England and ASGBI Jonathan Webb, Head of Safety & Learning, Welsh Risk Pool Professor Vivienne Harpwood, Emerita Professor of Medical Law and Ethics, Cardiff University Helena Durham, Lay Patient Safety Partner and member of the Ethics of Clinical Practice Committee at Nottingham University Hospitals NHS Trust Attendees will receive a CPD Certificate and complimentary access to EIDO’s foundation e-learning course, “The Legal Aspects of Informed Consent” following the event. Spaces are limited and free, so don’t miss this opportunity to join vital discussions on improving patient safety through better informed consent practices. Register here.

This Patient Partnership Week webinar will ask the question, "Why aren't patients treated as equals in their own care?" Prof Havi Carel from the University of Bristol will discuss why some healthcare professionals ignore, dismiss or explain away patients' testimonies about their health. Register for the webinar

This course will offer an overview of the law relating to medical treatment decisions, both children and adults, and both for patients able to make a decision for themselves, and where best interests decisions must be made for those who cannot, and how to tell the difference. We will also look at how, and when, it may be necessary to involve the court to resolve disputes and – better – how to avoid disputes altogether. Decisions about medical treatment can be about life and death, such as withdrawal of treatment or (not) providing CPR. Or about quality of life, liberty and independence, which can be just as important. But the legal (and ethical) framework around these decisions is often misunderstood, leading to distress and disputes at the very worst of times, as we have seen in a few very high-profile cases. It can also cause uncertainty and doubt in clinicians, where the law is misunderstood as a stick to beat them with, rather than a shield to protect their reasonable decision-making. We will cover whether a patient should always get what they want, or does “doctor know best”? When a patient cannot make a decision for themselves, who gets to decide, and how should these decisions be made? What is the role of so-called “next of kin” (and did you know that there’s actually no such thing)? Can parents insist on treatment for a child when doctors think it futile? How are disputes in this context resolved and, better yet, how are they avoided? Throughout, we will talk in particular about the importance of good communication, and managing expectations, and how to ensure that clinicians are doing the right thing for the patient, as well as avoiding getting sued. Key learning objectives: To understand and apply in practice the fundamental legal framework around decisions about medical treatment, including: Rationing and resource allocation The limits of choice and autonomy The relationship between law and ethics The importance of good communication, and how to not get sued The law on consent Mental capacity and best interests decision for adults Decisions about children – Gillick competence, parental responsibility and disputes Restraint and deprivation of liberty Going to court Register