Month: July 2019

A Senate Inquiry Recommendation on Informed Consent? Really?

In 2017, the Senate Inquiry into the number of women impacted by pelvic mesh implants had a Recommendation actually spelled out how a medical practitioner should undertake informed consent.

Does that not give one pause? I mean, shouldn’t that always be happening?

Let me quote the recommendation that appeared in the final report of the Senate Inquiry1 into the number of women impacted by transvaginal mesh implants and other matters:

The committee recommends that the Australian Commission on Safety and Quality in Health Care prepare guidance material on effective informed consent processes, with a view to ensuring that a dialogue between a medical practitioner and patient should:

  • clarify the rationale for the proposed treatment;
  • discuss the range of alternate treatment options available and their attendant risks and benefits;
  • discuss the likely success and potential complications of the recommended treatment as they relate to the individual patient;
  • provide an opportunity for the patient to ask questions; and
  • confirm that the individual patient has understood the information discussed.

It does seem incredible that it was felt that there was the need to spell out how to do it, but in case anyone wanted to know how, here is some guidance.

To be fair, consent is a vexed issue, and there are many barriers to it working well. To quote a recent article Medical Republic2, “There are about 60,000 things that can go wrong with a human body, 6000 drugs and 4000 procedures you can do – patients can’t be across that… Healthcare is complex and cannot be simplified.”

It’s true that we don’t know what we don’t know – but being empowered to ask can really change how a consultation proceeds. The Five Questions to Ask Your Doctor (Choosing Wisely) and the Question Builder Tool (Australian Commission on Safety and Quality in Health Care) are two resources that can help put you back in control of what you say yes to, and just as importantly, what you can say no to.

It’s your body – no one else has anywhere near the stake in the outcome of a health care episode as you do, so by all means, ask.

 

1:https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MeshImplants/~/media/Committees/clac_ctte/MeshImplants/report.pdf

2: http://medicalrepublic.com.au/patient-centric-care-beyond-buzzwords/21578/

Royal Commission into Aged Care – CHF Survey closes 18th August

The Consumers Health Forum of Australia (CHF) are preparing a submission to the Royal Commission into Aged Care Quality and Safety and want to include the views and lived experiences of consumers front and centre of our response. They have developed an online survey which relates to different sections of the Terms of Reference.

Click here to complete the survey

The survey will close on Sunday, 18 August 2019. Any questions about the survey can be directed to CHF’s Safety and Quality Policy Officer, Leanne Kelly (l.kelly@chf.org.au).

Why am I here? Because Informed consent…

This week, the I have the honour as the Health Consumers’ Council Executive Director to be guest tweeter on the Croakey @WePublicHealth page for the week of 15th July 2019.

For the first tweet I thought it only polite to introduce myself, and it got me to thinking again – why am I here? Why am I in this role? Why did I choose the topic of Informed Consent this week? In many ways informed consent is at the heart of most health complaints, and is a core part of why I believe in the importance of the work of the Health Consumers Council.

My passion for informed consent started from this GP conversation that happened to me and I would suspect pretty much every pregnant women in Australia:

GP: Congratulations, you’re pregnant! Do you have private health insurance?

Woman: Yes

GP: Which obstetrician would you like?

This is not an informed consent conversation. Why not? Because there is no mention of midwifery-led services here. There is no nuanced conversation about the evidence-based models of care that note that if you are low risk, you don’t actually need an obstetrician.

Like many people, my first real adult interaction with the health system was when I was pregnant. It really got me thinking, why is it so hard to access evidence-based models of care because they happen to be midwifery led? In my nearly twenty years as a consumer representative, I don’t believe this initial GP conversation has shifted in the way I hope it will in time.

I also think this type of conversation is by no means unique to maternity care, and that the path from the GP to a surgical specialist is short, with not enough detours past midwifery, nursing and allied health professionals. Not so long ago, my partner came off his bike and attended a GP. The advice was that it possibly was a full thickness rotator cuff tear in his shoulder, and surgery was required. However, the physiotherapist he went to noted it was a partial tear and gave him exercises. It healed beautifully over the next six to eight weeks without any need to trouble the surgeon.

Don’t get me wrong, I am very committed to the importance of having a really good GP that knows you over the course of your life, and here at the Health Consumers Council we regularly advise consumers to invest time in finding the right GP. I am very attached to my GP and she is a really key part of my wellness plan. But GPs are usually the gateway to the path of care we can travel, and it’s important that we choose the right care for our circumstances. The consumer always pays the ultimate price for their own health care choices.

Twenty years ago, after much research and some very good luck at stumbling across a birthing centre in a local hospital, plus the grace of everything going well on the day, I was able to have the drug free delivery I was hoping for. I have never forgotten the day my daughter was born. The medical and midwifery staff would have gone home at the end of the shift and likely not given it another thought.

In short, informed consent is a fundamental consumer right. And to exercise that right, we need to know that a) it’s OK to ask questions, and b) it’s also OK to say “can I think about this” or even “no” to suggested treatments.

Pip Brennan is Executive Director of the Health Consumers Council in WA, and independent, not for profit organisation dedicated to ensuring the consumer voice is at the heart of health policy, service planning and review. Pip has worked in the community sector for the last 18 years. Inspired by her own experiences of the confusing maternity care system, Pip initially volunteered as a maternity consumer representative in a range of roles. She began her paid health career as an Advocate working at the Health Consumers’ Council (HCC) from 2006. She has been a conciliator of health complaints, a health NGO professional and always a firm believer in the value of consumers being at the table. She took on the role of Executive Director of the Health Consumers Council in WA from 2015 and was a panel member on the state’s recent Sustainable Health Review.

Complaints Policy CLOSES 24th July

The Department of Health (DoH) are consulting on a revised version of the WA Complaints Management Policy. They have prepared a number of documents as part of their review. They are seeking feedback from consumers on this policy and the associated documents.

While some of the documents are long, and seem to be written for a staff audience, at HCC we believe this consultation is an important opportunity to provide feedback to the Department and the system about the experience of consumers, carers and their families when making a complaint about health services.

To provide feedback

HCC is gathering two kinds of feedback:

1. We are interested in your feedback on the draft revised Complaints Policy and associated documents – please review those documents and provide your feedback on those here

2. We are also interested in your feedback about the experience of making a complaint or providing feedback. If you have an experience you would like to share, please complete this online survey form.

The DoH consultation close 26th July 2019 – to give us time to collate responses, please complete your feedback to HCC by WEDNESDAY 24 JULY.