Informed consent - a survey of doctors' practices in South Africa

Objective. To examine doctors' practices with regard to informed consent.Design. Cross-sectional, descriptive survey.Participants 'and setting. All full-time consultants and registrars in the Departments of Medicine, Obstetrics and Gynaecology, Paediatrics and Child Health, Paediatric Surgery and Surgery at the University of Cape Town were included. The overall response rate was 63% (160/254).Measurement. Data were collected by means of selfadministered, semi-structured questionnaires.Results. Most doctors (79%) felt it was their responsibility to ensure that patients and parents were fully informed about diagnostic and therapeutic interventions. Many (62%) supported a patient-centred standard for determining the type and amount of information to disclose. Doctors disclose most of the legally required information except for information about alternative forms of treatment and remote serious risks. They almost never provide information on medical costs. The most common reasons for not obtaining informed consent were the doctors' tendency to 'tell' patients! parents what they intend doing and their belief that patients/parents expect doctors to know what is medicallybest for them. Language, inadequate communication skills and lack of time were, surprisingly, seldom viewed as obstacles to the obtaining of informed consent. Findings were independent of discipline (medical or surgical) and doctors' status (consultant or registrar). Doctors who treat children were significantly less likely to obtain consent forcertain interventions.Conclusion. Doctors meet many, but not all, of the legal requirements for informed consent. The findings question whether informed consent as envisioned by the law existsin reality. Cross-cultural research is needed to clarify patients' and parents' expectations of informed consent