Abstract
Dear IAAPSIANS,
Unity among our members is a priceless asset. Working together, we can achieve remarkable milestones that would be unattainable alone. The age-old adage ‘Divided we fall’ is not merely a childhood moral story—it is a principle that guides our association’s work.
Progress in Consent Documentation
I am delighted to inform you about the successful completion of the second phase of our consent documentation project. During my tenure as Secretary from 2018 to 2021, I extensively studied the concept of consent and its evolution throughout human history. Notably, Hammurabi, the ancient ruler of Babylon, established a civil code that marked a significant step in the development of civilisation. However, he imposed severe punishments on physicians for unsuccessful treatments, such as the ‘eye for an eye’ penalty for failure in treating ocular problems in 1700
Types of Medical Consent
Presently, two major models of medical consent exist:
The British system: This model requires practitioners to inform patients about common, important complications. Uncommon complications may not necessarily be disclosed. The American system: Here, practitioners must not only detail all complications, both common and uncommon, but also provide information about alternative treatment methods.
Development of Consent Forms
Inspired by the American model, I developed a prototype consent form for large volume liposuction, which includes a section for patients to record their expectations. Additionally, there is space for the doctor to clarify which expectations can be met and which cannot.
It soon became clear that creating all consent forms single-handedly was impractical. Furthermore, consumer law places emphasis on peer practice, meaning practitioners are expected to possess skills comparable to their peers, rather than guaranteeing success in every case.
Many IAAPS members graciously volunteered their support. I created a prototype with key headings and shared it, along with the large volume liposuction sample, with primary authors. Senior faculty then provided corrections, and finally, younger practitioners formatted the documents according to the original pattern.
Standardisation and Additional Forms
We decided to maintain separate consents for videography, photography and common complications, thereby ensuring uniformity in the information provided to patients. Procedure-specific consents focus solely on complications relevant to the specific procedure.
A patient declaration form was also introduced, requiring patients to disclose past and present illnesses, surgeries, habits, medications and family history. This form, to be signed by the patient, ensures that if any information is withheld, the surgeon is not held responsible for subsequent consequences.
Patients must also declare their kin, provide identification for both parties, and allow the kin to receive the documents and sign a receipt in the prescribed format.
Translation and Legal Review
In the past six months, Aesurg26 ambassadors have translated the consent forms into seven major Indian languages, assisted by numerous IAAPS members. My heartfelt thanks to everyone involved in accomplishing this monumental task.
Dr Rajendran and Dr Vikram, who has also completed his LLB, have suggested some changes that will be incorporated in due course. The association extends its gratitude for their valuable input.
These consent forms have been well received in courts of law, appreciated for their clarity and comprehensiveness. We plan to introduce the next set of consents soon.
Recommendations for Uniform Practice
I urge all members to use these consent forms and maintain uniformity in informing patients. This practice will lessen the anxiety about losing patients due to the disclosure of rare but severe complications, such as blindness in blepharoplasty.
It is advisable to send the consent form to patients by email 4-5 days before surgery. This allows them time to read, understand and raise any queries or doubts before signing the document on the day of the procedure.
Legal Compliance and Peer Practice
Through these measures, we strive to fulfil all legal requirements of consent, including providing documents in a language that the patient understands. This approach also establishes peer practices in the court of law.
Concerns Regarding Video Consent
I have reservations about video consent, as currently recommended by lawyers and police authorities. We typically meet patients three to four times before surgery and allocate ample time for counselling, resulting in extensive data that are challenging to maintain.
Subjecting ourselves to third-party scrutiny—such as analysis of facial expressions, intonations and voice modulation—is not ideal. Judicial proceedings can be lengthy, and by the time a verdict is delivered, practices may have evolved and some details may be lost. It is not uncommon for recent practices to be retrospectively applied to incidents from the past.
Given the prevalence of deepfake technology, entrusting video consents to external parties is inadvisable.
I am confident that my colleagues share these concerns and will continue to support this project, ensuring its benefit to all.
Suggestions are always welcome.
Invitation to Annual Conference
I am thrilled to invite you all to our annual conference, Aesurg26. We have incorporated many new ideas, which can only be realised with your participation.