The Surgery Consent Forms
Why THRF Advocate This?
The number of unnecessary surgery performed is surging in Taiwan. A 2000 survey showed close to 25,000 female patients had uterus removal operation and around 20% of the operations (4,722 cases) were unnecessary or proceeded without prudent consultation with the patients.
The surgeries relate to knee, breast and uterus ailments are more prone to these ill-considered operations. And the root causes of such phenomena are both culturally and systematically oriented. System wise, the National Health Insurance (NHI) payment system plays a part in encouraging surgeons to rush decisions over simple surgeries in order to get more reimbursements. On the cultural perspective, patients in Taiwan generally are reluctant to question medical professional's opinions. And this communication gap prevents both surgeons and patients to fully understand their rights and obligations when making important medical decisions.
In order to address issues mentioned above, we believe it is important to introduce detailed surgery consent to provide patients with sufficient information prior to procedures.
Press Conference, July 2003
The unnecessary surgeries are both threat to patient's safety and waste of the public healthcare resources. In a press conference at July 2003, we push the government to introduce an improved regulation on the surgery consent form.
During the press conference, we used surgery consent forms from other developed nations as the comparison to Taiwan's current consent forms. The comparison showed that consent forms in Taiwan generally lacked of sufficient information about the nature of the procedure and the patient's rights. We urged the government took responsibility by imposing a universal standard on the surgery consent forms. The following is a list of items that we believe should be included in the consent forms:
1. Name of the patient's condition
2. Name of the recommended operation
3. Reasons for the recommendation of the operation
4. Implementation of the operation
5. The success rate of the operation
6. The risk rate for each possible complication
7. The special risks for the individual who is about to receive the operation
8. The medical dangers of different complications, and how the medical team will respond to the possible complications during the surgery
9. The preparation status of the medical team
10. The alternative treatments, and their potential risks
11. The operative-assessment and care
12. Declaration of the patient
13. Declaration of the physician
Among all items in this list, "the reasons for the recommendation of the operation" should be consider the most crucial in closing the communication gap between patients and surgeons. The item helps the patients understand the procedure of the operation, at the same time prevent them fall victim to the unnecessary procedures set up for extra reimbursement. The declaration from both patient and physician, on the other hand, are to make sure patient fully aware the nature of the operation, and agrees to undergo the surgery.
We also recommends the consent form be handed to the patient several days prior of the operation during the non-emergency situation. The patient, the surgeons, the hospital and the Bureau of National Health Insurance should each have a copy of this consent form for reservation and recording purposes.
The Department of Health (DOH) responded our suggestion by introducing a new version of surgery consent form at August 2003. The new regulation required the forms to include the information such as how the operation be carried out, the possible complications and the patient's rights.
Other Activities: Consent Form Lottery
In order to investigate the effectiveness of the new consent form which was implemented since January 2004, we hosted an activity to collect new surgery consent from across Taiwan along with another general survey. The event “The Operation Consent Form Lottery" from June to October 2005 was a price winning activities in which the public sent us copies of surgery consent forms to participate a lottery.
A total of 633 valid surgery consent forms were collected from 18 medical centers, 49 regional hospitals, 31 local hospitals and 16 clinics over 21 counties and cities in Taiwan. Unfortunately, the result showed still more than 70% of the consent forms missed the declaration or signature from either patient or the doctor, whereas 86% provided incomplete or substandard information. From a phone survey carried out during the same period of time, more than 90% of respondent stated that they had been briefly informed before the operation, but only 15% of them had received complete briefing on the surgery.
Government’s Response to the Consent Form Lottery
– The proper implementation of surgery consent forms will be included in the first half of 2006 as a review item in the regular internal review of hospitals.
– Bureau of National Health Insurance will not reimburse the costs of operation or anesthesia to hospitals that do not provide copies of completed surgery consent forms.
Other Activities: Promotion Leaflet
In order to raise the public awareness on this issue, we also distribute free leaflets "Three thoughts and eight questions before the operation" to the public. The leaflet includes the information divided into two categories:
1. Three things to consider:
a. Should I undergo this operation?
b. What kind of operation it is?
c. What would happen after the operation?
2. Eight questions to ask:
a. Why do I need this operation?
b. What will happen if I don’t undergo this operation?
c. Are there any other alternative treatments?
d. What kind of operation do I need, and what are the possible complications?
e. What type of anesthesia do I need, and will there be a professional anesthesiologist supervising my operation during operation?
f. Who will be in charge of this operation, and what is his or her professional reputation?
g. Approximately, how long will it take for recovery after the operation?
h. What other question do I have regard to this operation?
More than 6,000 copies of the leaflets were distributed in hospitals and other public areas or through promotion seminars. The public can also access this pamphlet freely by contacting THRF directly, or download it on our website.