Informed Consent
SUKHIT PHAOSAVASDI, M.D.*, SURASAK TANEEPANICHSKUL,M.D.*, YUEN TANNIRANDORN, M.D.*, PINIT KULLA VA NUA YA, M.D.**
Affiliation : * Member of the Medical Association of Thailand, Bangkok 10310. **Department of Medicine, Faculty of Medicine, Chulalongkom University, Bangkok 10330.
Information to make patients fully aware of all the details of treatments is an important part
of the medical practice before obtaining patient's signature in the consent form. Explanation may
be detailed enough to make patients understand the process of treatment. However, sometime it
may not be inclusive enough to cover all major statements that give pros and cons of the treatment.
Perhaps detailed explanation may reveal too much information that may discourage patients to receive
treatments and cause fear, anxiety, and hopelessness. If health care personnels do not mention all
the risks involved in medical treatments, they may be subjected to an accusation of conceal
ing the truth that should be made known to patients. This is one of many ways of looking at the pro
blems. There is no easy answer to the problem of what 'appropriate' explanation should be. Most
of our patients are from all walks of life which are not medical profession, and they do not have
knowledge to understand technical terms. How should we approach patients in order to be safe from
an accusation of that we are not over supporting, not giving the patients false hope?
Therefore, we would like to present a guideline for informing and explaining to the patients
under the following headingso-s>:
1. Diseases or major symptoms which are diagnosed.
2. The necessity to receive treatments for the benefits of patients or fetus.
3. If possible, determine the duration of treatments.
4. Methods of treatment, evaluation, and schedule for next appointment.
5. Inform about necessary investigations.
6. Inform about complications of risks, and cost of investigations
7. Usefulness and results of investigations.
8. If options of treatments are available, they should be explained in details, the pros and cons,
the risks, and the costs, etc.
9. Maintaining medical confidentiality and the use of patient chart by medical personnel and other
related health care providers, for instance, hospital staffs from all levels, medical students, tech
nical medical students, and social workers, etc.
10. Advise that certain treatments may involve risk and danger, for instance, the placement of hot
water bottle, falling from beds, collapsing in the bathroom, the use of air conditioner or other
electrical appliances, drug allergies, hospital acquired infection, the stealing of newborn and
belongings, injuries from venepuncture, blood transfusion, operative risk, drug misuses (drug
given at the wrong time & wrong patients), personnel shortage, lack of medical equipment, etc.
11. Advising ward nurses and other staffs for assistance including public relations.
12. Advise the 10 rights of patients, especially the right to deny treatment and refuse temporary or
regular drug intake.
13. Side effects on fetus after the medical investigation, treatment, operation, drug treatment, or after
refusing the treatment.
14. Public health care centre cannot deny treatment to any patient.
15. Certain medical treatments are sophisticated and prohibitively expensive. Thus, it cannot be pro
vided at all public health care centers.
16. Patients have the right to receive treatment.
17. The various medical treatments such as drug prescription, operation, use of medical instruments,
are varied according to physicians' expertise and availability of doctors.
18. Inconvenience in receiving medical treatment depends on the number of patients and staff per
sonnels.
19. All treatments must have the same standard throughout the country.
20. Patients and relatives can always meet hospital administrators for details and better understand
ing of treatments and service policies.
All the above statements, if understood by the hospital staffs, patients and relatives, may
bring the end to our problem to a certain level. The administrators must be confident that their
hospital staffs are ready to work efficiently with a clear interpretation of the above guidelines. In
addition to the medical knowledge the administrative committee must be committed to inspect and
make the guideline effective so that the patients will sign the consent form willingly with beneficial
results to patients in order that it eradicates the patients and their relatives' misunderstanding to the
health care institution from the beginning. This is better than giving excuses or trying to solve
problems when the problem is arisen. For example, when the patient's medical confidentiality is
disclosed and the patient sued the hospital resulting in the necessity of buying warrants against sueing
as in the Western countries.
In the past, this matter had not been written down clearly and was neither a problem in
giving treatment to patients. However, problems have already happened in Thai society and informed
consent is unavoidable and must be done efficiently. Hopefully, physicians and nurses will be fully
aware of the informed consent that we are facing presently. It is not a law, regulation, order, but it
is expected of us, doctors and nurses, by society to do more than what we are already doing and
being praised for.
Keywords : Informed Consent
