Informed consent in elective gynecological surgery

According to the regulations of the Law of patients’ rights, consent to a surgery is an act of sanity, demanding a patient to be mature, with full mental capacity and with information available providing the possibility of valid decision making . A patient has the right to decide with free will on everything regarding his/her life and health; not a single medical treatment can be undertaken without his/her approval . A patient has the right to information necessary to make the decision on giving consent to the medical measure (risks of both the undertaken and not undertaken procedure, possible consequences, alternative treatments). The information ought to consist of a diagnose, prognosis, a brief medical measure description and its duration. The consent can be given in an oral, written or silent way. For an invasive procedure, a written consent must be given. The notification language needs to be clear and the procedure wellexplained . The signature needs to be willing, signed under no pressure. The consent can come out of a communication implying an active involvement of both sides, or the doctor is allowed to make the decisions. The communication ought to be initiated by the doctor who is supposed to give information on the character of the disease, the surgery plan, prognosis and existing alternatives. It is necessary to inform the patient about the consequences (usual consequences: inability to work and perform everyday activities) and also about the possible complications (in spite of the degree of probability of their occurrence). There has been an active question on how much information a patient needs. Most doctors share an opinion that little should be said. A patient needs to understand the risks of an intervention/non intervention and to possess the capacity of decision making . Doubting patient’s competency imposes the need to consult her parents, guardians, a social worker or a psychiatrist for an evaluation of her mental status and the capacity of decision making. The exceptions are some urgent situations which suppose the doctor to react for the patient’s best benefit . Indecisive patients are advised to read some literature, brochures, and even some Internet sites, to gather more information . Modern means of communication (the Internet, forums) can be both useful and harmful in the process of getting information; so, relevant sites ought to be recommended. Articles advising non-standard new surgical techniques and procedures represent a special issue if a patient requires them to be included in the treatment. In this case, only through a conversation about the benefits and the risks of such procedures, based on scientific proofs, the doctor and the patient should reach a mutual agreement. Otherwise, the patient may ask for another opinion . Consent to the intervention and the risk does not make the doctor free from responsibility. Many patients often don’t read the details of the informed consent. The reason for that mostly lies in the doctor-patient relationship, in which the doctors find themselves in the position of the ones possessing knowledge, information and even a certain amount of power. This kind of paternalistic physician-patient model was predominant in the past. The opposite way is a doctor to help the patients discover their best interests after evaluation of their own needs, expectations and beliefs. Sometimes, through such conversations, the patient’s need for a certain intervention may disappear, and also, the counseling to initiate a surgical intervention instead . Another model is a tutoring doctor-patient relationship, in which the doctor (the one who knows what the best is) stands opposed to the passive, partially informed, almost believing patient. This kind of a relationship is a relic of the past and considered to be unacceptable in the modern medicine 6, . We tend to achieve a balance in this unequal doctorpatient relationship and to create a partnership. In that case, the possible complications would rarely become an issue at court trials and requests for material and non material damages. In the era of serious debates on human rights, the rights of patients, the right to quality information and the right to free choices are genuinely some of the crucial ones in medicine. In our prospective study of the informed consent, we included 100 randomly chosen patients who underwent the elective gynecological surgery and who filled an anonymous