08 Nov 2020

Your choice: Guidance for doctors and patients on decision-making and consent

The General Medical Council (GMC) has issued updated guidance on decision-making and consent for patients, effective Monday 9 November 2020.

The GMC is the UK's regulatory body for the medical profession and as part of this role it provides guidance to medical professionals on a range of medical areas.

This latest guidance is specifically about decision-making and consent and refreshes guidance that was last issued in 2008. 

Latest GMC guidance on decision-making and consent

Why are the changes to this guidance on decision-making and consent important for patients?

The updated guidance sets out seven principles for decision-making and consent. These emphasise the importance of decision-making and consent as a dialogue between you and your doctor. 

The principles also highlight the importance of an informed choice - you are entitled to hear about a range of options and you are entitled to the information you need to make your decision about your treatment. 

This element of the guidance has been updated largely as a result of the Montgomery ruling in 2015 which said that patients are entitled to a meaningful and clear conversation about risk - which should include information about alternative treatments.

Why might the changes help women in midlife?

We hear all the time from women who are not offered or who are refused HRT by their doctors because of the doctor’s own beliefs about the risks and benefits of this as treatment for menopausal symptoms. 

This new guidance sets out more clearly how decision-making and consent should work and that it is your right to hear about alternative treatment options as well as proposed treatment options from your doctor. 

As an example, section 48-49 covers what doctors should do if they disagree with your preferred choice of treatment:

  • Section 48: “You must respect your patient’s right to decide. If their choice of option (or decision to take no action) seems out of character or inconsistent with their beliefs and values, it may be reasonable to check their understanding of the relevant information and their expectations about the likely outcome of this option and reasonable alternatives. If it’s not clear whether a patient understands the consequences of their decision, you should offer more support to help them understand the relevant information. But you must not assume a patient lacks capacity simply because they make a decision that you consider unwise."
  • Section 49: "If a patient asks for treatment or care that you don’t think would be in their clinical interests, you should explore their reasons for requesting it, their understanding of what it would involve, and their expectations about the likely outcome. This discussion will help you take account of factors that are significant to the patient and assess whether providing the treatment or care could serve the patient’s needs. If after discussion you still consider that the treatment or care would not serve the patient’s needs, then you should not provide it. But, you should explain your reasons to the patient and explore other options that might be available, including their right to seek a second opinion."

Our hope here at The Latte Lounge is that this guidance provides you with more rights to access HRT if this is the treatment option that you want to choose. (For more about the risks and benefits of HRT, please see our feature with renowned specialist Dr Avrum Bluming.)

You may therefore find it useful to print off the updated guidance and take it to your doctor’s appointment.  

What else is in the updated guidance?

You can read the full guidance on the General Medical Council website.

The seven principles of decision-making and consent shared in the guidance are as follows: 

  • Principle one All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
  • Principle two Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
  • Principle three All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.
  • Principle four Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.
  • Principle five Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. A patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements.
  • Principle six The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those who are close to them or advocating for them.
  • Principle seven Patients whose right to consent is affected by law should be supported to be involved in the decision-making process, and to exercise choice if possible.

Has this updated guidance on decision-making and consent helped you access your preferred choice of treatment? Please let me know if you have success!

Further reading: Explore all of our perimenopause and menopause resources including our symptom checklist.

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