Annex A > Chapter 17 - Communication Between Healthcare Professionals and Patients > Guidance from professional and related bodies > The Royal College of Surgeons of England
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The Royal College of Surgeons of England
37 Sir Barry Jackson, the President of the Royal College of Surgeons of England (RCSE), gave the Inquiry his views on discussions with patients in the following exchange:
`Q. If I can just turn then to another aspect of this particular document, [50] ... the subject of how doctors explain risk to patients. It sets out the relationship between the consultant and the patient, the fact that areas of uncertainty and significant risk must be explored, the use of information leaflets and tapes, and then, at the bottom of that it says:
`"The Colleges and specialist associations have an important role in the production of suitable information on a national basis but the surgeon must know and divulge local and personal figures." [51] For the success or otherwise of an operative procedure, presumably.
`That is clear guidance from the College published in 1998. What would have been the standard in this area throughout the period of our Terms of Reference?
`A. I do not think it would be so explicitly stated as it is stated here for surgery in general. I cannot speak for particular branches of surgery and specifically for cardiac surgery because I do not know, but it would certainly have not been in any way firm College guidelines that on a national basis surgeons should divulge local and personal figures relating to outcomes such as has been recommended in this document.
`Q. Our understanding is certainly that there was no guidance to that effect because we are looking at a 1998 document that I think is clearer than any other on that subject, but are you able to help us on the practice that would nevertheless have been adopted at a local level?
`A. I think it would have been uncommon, unless the patient had asked for that information. I imagine that that might differ from specialty to specialty within surgery because my understanding is that in the field of cardiac surgery, very high risk surgery, this information was not infrequently asked by relatives or by patients of the surgeon in question, whereas in other branches of surgery, it would have been extremely uncommon to have been asked that question.
`Certainly, from personal experience, not as a cardiac surgeon, I think I would have been asked specific questions regarding risks in general and certainly the risks in my own hands exceedingly - exceedingly - infrequently over my entire professional practice.
`Q. The Inquiry will, of course, hear from parents and also from the doctors concerned as to what their practice was, but it might be suggested that it would be unusual for a patient to be able to have the knowledge, as it were, to ask not merely about what the outcome or likely outcome was in broad terms, but to be able, to make a distinction to go behind a 30 per cent risk of mortality, to ask such further questions as, "Well, is that a national figure, is that a local figure, is that your personal figure?"
`That would accord with your experience, that patients did not really do that?
`A. Absolutely. I think it would have been most unusual for any patient to do that, and I would imagine, but others will be able to verify or refute my belief, that that would have been unusual in cardiac surgery, and specifically in paediatric cardiac surgery.
`Q. So this is an area where practice must have changed very recently and very rapidly?
`A. Well, I think that it does not happen now. I do not think patients by and large ask that information, other than, perhaps, in the field of cardiac surgery, largely, I suspect, as a result of the publicity that the circumstances in Bristol obtained.
`Q. What is being suggested in that guidance is that it is not merely surely a matter for the patient to ask, but for the doctor to volunteer this information?
`A. That is what is stated, correct.
`Q. But so far, does it follow from your earlier answer that that is not necessarily the practice, or is not common practice on the ground?
`A. I think that is probably not common practice, and as I have - I think I have not said specifically, but if I have, I am sorry to repeat it; if I have not, perhaps I could say that any College guideline that comes out, such as the one you have on the screen at the present moment, is a recommendation by the College to its fellows and others, but it is not mandatory upon our fellows and others to follow those guidelines or those recommendations.' [52]
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Footnotes
[50] RCSE 0001 0009; `Response to the General Medical Council Determination on the Bristol Case', The Senate of Surgery of Great Britain and Ireland, Senate Paper 5, October 1998
[51] RCSE 0001 0009; `Response to the General Medical Council Determination on the Bristol Case', The Senate of Surgery of Great Britain and Ireland, Senate Paper 5, October 1998