We supported a number of medical students facing disciplinary proceedings after they examined an unconscious patient in the operating theatre. The examination was not part of the procedure, but done under the direction from their supervising surgeon to demonstrate their skills for a particular part of their training.
a nurse or anaesthetist who makes the complaint. On one occasion, a nurse
actually objected at the time of the examination but was overruled by the
disciplinary proceedings, students are asked why it didn’t occur to them that
consent may not have been obtained, and why they didn’t ask more questions
before complying with the supervisor’s instruction.
a challenging area of medico-legal law and doctors can struggle with it at any
point in their careers. So what are the consent issues you need to be aware of in
the operating theatre?
All along you’ve been
taught about the importance of consent
carefully instructed in your pre-clinical years about the importance of
obtaining consent from patients before taking a history or performing an
examination. You are taught to introduce yourself both by name and by role
before asking permission to interact with a patient.
How do you
apply this in the operating theatre with an unconscious patient?
have to rely on hospital process and be comfortable that their supervisor has discussed
with the patient that students may be present during their procedure. Students
have to assume their supervisor has obtained specific permission for any
examination by the student or involvement in the procedure in their consent
discussions with the patient.
If it’s not a standard
part of the procedure, you need consent
treatment is provided by a team of people in public hospitals, it may well be
that ordinary consent to undergo, for example, a laparoscopic procedure is
sufficient to cover a student holding equipment or doing some part of the
comes if you are directed to perform an examination, which is not necessarily
part of the treatment, but solely for you to learn a clinical skill.
has been accepted as part of a doctor’s training for over a century, because it’s
not part of the operative procedure, it’s not covered by standard consent.
If your clinical
supervisor instructs you to examine a patient who is unconscious, a number of
practical issues arise:
not in a position to get consent from the patient
don’t know what was discussed with the patient during the consent process
significant power imbalance exists between you and your supervisor
probably only have seconds to decide what to do.
Where do you stand?
It’s the university’s
responsibility to ensure training supervisors don’t direct students to contravene
the Medical Board of Australia’s Good medical practice: a code of conduct for
doctors in Australia.
a student you should be able to recognise a request where consent may not have
been obtained and question this. Ultimately, it’s up to you to abide by the
things you can do:
- Familiarise yourself with our
factsheet Consent essentials.
- Be willing to respectfully challenge
an instruction which is at odds with your training.
- If you have any concerns, contact
Avant for assistance and advice.
How Avant supports
students in disciplinary proceedings
helped a number of students with complaints regarding consent. We ensure
students are treated fairly and argue that a student’s junior position in the
theatre during training can make their ability to question or refuse, extremely
students often ask us, ‘Why do I need insurance?’ This example is a very good
reason why it pays – or not, since membership with Avant is free for students –
to be covered.
For medico-legal advice contact us at firstname.lastname@example.org or 1800 128 268, available 24/7 in emergencies.