Minor Surgery at a Glance

Helen Mohan, Desmond Winter, Desmond C. Winter

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781118561447
• eBook ISBN: 9781118561430
• Edition: 1
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

Minor Surgery at a Glance is an essential companion for those who wish to learn or familiarise themselves with minor surgery, including trainees and practising surgeons, dermatologists, GPs, and emergency medicine physicians. Covering the basic principles of minor surgery, as well as offering an overview of techniques and common procedures accompanied by step-by-step illustrations, this book also provides concise summaries of vital information and the clinical practicalities.

Providing an accessible and practical introduction to a rapidly expanding area of practice, Minor Surgery at a Glance is ideal for medical students, foundation programme doctors, and trainees in a wide variety of disciplines who perform minor operations.

Part 1
Avoiding and managing problems: principles of safe surgery

Chapters

1. 1 Consent
2. 2 Physical environment
3. 3 Set-up
4. 4 Instruments
5. 5 Infection control and prevention
6. 6 Human factors
7. 7 Focused history
8. 8 Specimen processing and reporting
9. 9 Follow-up
10. 10 Anaphylaxis
11. 11 Emergencies and resuscitation
12. 12 Audit and practice
13. 13 Communication and conflict resolution

1 Consent

The nature of consent

This medico-legal summary is based on current laws in Common Law jurisdictions (those which have their roots in the English legal system). The principles are, however, applicable to medical practice across other legal systems.

A doctor is obliged to obtain a patient’s prior agreement to any proposed treatment, intervention or procedure. This respects the patient’s right to be involved in their healthcare decisions. Consent may be implied from the conduct of the patient or circumstances of the consultation. But where there is an intervention or procedure with potential side effects or adverse outcome, then express consent, either verbal or written, must be obtained. Allegations of clinical negligence in cases of adverse or unexpected outcome now frequently include an allegation of failure to obtain proper informed consent in addition to allegations of negligent performance standard.

The three core elements of consent

1. Competence or capacity: A person is deemed to have capacity if they have the ability to understand the information given by the doctor, to weigh it up and to make a decision as to whether to accept or refuse the proposed treatment or procedure. The person must also be able to communicate this decision clearly. Particular care is required for a child under the age of legal consent (commonly 16 years); or where there is doubt about the mental health or intellectual ability of the patient; or if there is a physical difficulty impeding clear communication. In all of these circumstances, detailed consideration must be given to assessing capacity and there may be a need for the doctor to consult a medico-legal advisor.
2. Voluntariness: The doctor must also be satisfied that the patient is giving consent voluntarily and is not under any duress, coercion or undue pressure from any other person to either accept or refuse the proposed treatment or intervention.
3. Information disclosure: Providing sufficient information to the patient is a critical element of obtaining valid consent and the emphasis has shifted onto this element in modern clinical practice and medical law. It is also the most difficult element to define medico-legally.

The patient should be given information regarding:

1. Their condition, illness or disease
2. The nature, scope and significance of any proposed treatment or intervention
3. The aims and expected outcome
4. Any discomfort, common side effect or risks of the procedure
5. Any alternative or choices of treatment.

The patient must also be told that they are free to refuse treatment or to withdraw their consent at any time prior to the treatment.

How detailed should information be?

Different levels of detail are required to be given depending on the nature of the intervention. In all cases, the standard is what a reasonable person would expect to be told in order to make a fully informed decision. The standard level of information given to the patient must include an explanation of any frequent minor risks and of major risks (even if infrequent), which are sometimes referred to as ‘material risks’. In the case of medical necessity for the procedure there is a general and approved practice not to disclose minimal risks that might cause unnecessary anxiety and stress or might deter the patient from undergoing necessary treatment, but this must be the exception rather than the rule. When the procedure is not a medical necessity (sometimes called ‘elective’), the required standard of information provision is higher and tends towards full disclosure. Disclosure must also include direct and full response to specific questions raised by the patient about the procedure, including any complications. It is the substance of the disclosure that is critical to the validity of the consent rather than the mere formulaic existence of a written and signed consent form.

What is material risk?

The legal analysis of the meaning of material risk by the Courts has changed in recent times. The question of risk is no longer solely determined by the standards of the medical profession but is judged by the significance a reasonable patient would attach to the risk of the proposed treatment or intervention. What constitutes material risk involves consideration of both the severity of the potential consequences and the statistical frequency of the risk.

The adult patient

A competent adult patient must make the decision about a treatment or intervention themselves. No one else is entitled to make that decision for them. If not competent, then other persons may be in a position to contribute to such a decision using a combination of tests of substituted judgment (as if standing in the shoes of the patient) and ‘best interests’ of the patient. In the event of a dispute between next-of-kin and/or health carers over such a decision, the Courts may ultimately be asked to make the decision.

The child patient

In the majority of Common Law jurisdictions, statute laws are in place by which a child under 18 years but who is 16 years or over is considered legally competent to give consent to medical, surgical or dental treatment. However, doctors should be familiar with local, national or state legal provisions that provide for vari...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• Preface
• Part 1 Avoiding and managing problems: principles of safe surgery
• Part 2 Basic pain control and anaesthesia
• 17 Skin incisions
• 18 Principles of wound closure
• 19 Sutures
• 20 Needles
• 21 Diathermy
• 22 Dressings
• 23 Haemostasis
• 24 Hypertrophic and keloid scarring
• Part 4 Practice of minor surgery
• INDEX
• End User License Agreement