OET Rx (Student Pre-Class)
Lesson 24: Obtaining Informed Consent for Major Surgery
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Course Progress
Part 1: Lesson Objectives
By the end of this lesson, you will be able to:
- Structure a formal conversation to obtain informed consent for a major procedure.
- Clearly explain the potential benefits, significant risks, and common complications of a surgery.
- Discuss the alternatives to surgery, including non-operative management.
- Use the "teach-back" method to confirm the patient's genuine understanding before they sign the consent form.
Part 2: Vocabulary & Examples
General Vocabulary
logical /ˈlɒdʒɪkl/:
منطقی
The logical next step, now that conservative management has failed, is to consider a surgical procedure.
long /lɒŋ/:
طولانی، بلندمدت
While the surgery has a long recovery period, the long-term benefits for your quality of life are significant.
look (v.) /lʊk/:
بررسی کردن
We need to look at all the potential outcomes, both positive and negative, before you make a final decision.
lose /luːz/:
از دست دادن
There is a very small risk you could lose some sensation in the skin around the incision.
loss /lɒs/:
از دست دادن، فقدان
Blood loss during this type of major surgery is expected, and we have measures in place to manage it safely.
low /loʊ/:
کم، پایین
Fortunately, the risk of serious complications for this procedure is very low in a patient with your health profile.
lower (v.) /ˈloʊər/:
کاهش دادن
The primary goal of the surgery is to lower the pressure on the nerve and thereby relieve your pain.
lung /lʌŋ/:
ریه
A post-operative risk we take very seriously is a chest infection, so we will have physiotherapists help you keep your lungs clear.
machine /məˈʃiːn/:
دستگاه
The heart-lung bypass machine will take over the function of your heart and lungs during the operation.
main /meɪn/:
اصلی
The main benefit you should experience after this surgery is a significant reduction in pain.
mainly /ˈmeɪnli/:
عمدتا، بیشتر
The recovery period will mainly involve rest and gentle physiotherapy.
maintain /meɪnˈteɪn/:
حفظ کردن
We will work with you to maintain good pain control throughout the post-operative period.
major /ˈmeɪdʒər/:
اساسی، ماژور
This is a major operation, and it's essential that you understand all the components before we proceed.
majority /məˈdʒɒrəti/:
اکثریت
The vast majority of patients who undergo this procedure have an excellent outcome.
make /meɪk/:
گرفتن (تصمیم)
My role is to give you the information; the final decision is one you must make for yourself.
manage /ˈmænɪdʒ/:
مدیریت کردن
We have very effective ways to manage post-operative pain.
management /ˈmænɪdʒmənt/:
مدیریت
The alternative to surgery is the continued medical management of your symptoms, which we have already tried.
Medical Vocabulary
Anaesthesia /ˌænəsˈθiːziə/:
بیهوشی
The anaesthetist will speak with you separately to discuss the risks and benefits of the general anaesthesia.
Complication(s) /ˌkɒmplɪˈkeɪʃənz/:
عوارض
As with any major surgery, potential complications include infection, bleeding, and blood clots.
Informed Consent /ɪnˌfɔːrmd kənˈsent/:
رضایت آگاهانه
Obtaining informed consent is a crucial ethical and legal process, not just a signature on a form.
Non-operative management /nɒn ˈɒpərətɪv ˈmænɪdʒmənt/:
مدیریت غیرجراحی
We have exhausted all non-operative management options, which is why I am now recommending surgery.
Post-operative /ˌpoʊstˈɒpərətɪv/:
پس از عمل
In the post-operative period, you will be monitored closely in the recovery unit.
Potential Benefit(s) /pəˈtenʃl ˈbenɪfɪts/:
فواید بالقوه
The potential benefits of this hip replacement are significant pain relief and a major improvement in your mobility.
Recovery Period /rɪˈkʌvəri ˈpɪəriəd/:
دوره بهبودی
The full recovery period for this procedure can be up to three months, and it requires a commitment to physiotherapy.
Risk(s) /rɪsks/:
خطرات، ریسک‌ها
It is my duty to discuss the serious risks, even though they are rare, so you are fully informed.
Signature /ˈsɪɡnətʃər/:
امضا
Your signature on this form confirms that we have had this discussion and that you agree to proceed with the surgery.
Surgical Procedure /ˈsɜːrdʒɪkl prəˈsiːdʒər/:
فرآیند جراحی
The surgical procedure itself will take approximately two hours to complete.
Part 3: Pre-Class Practice Tests
Reading Task (Longer & More Professional):
Excerpt from "Medical Law and Ethics: A Practitioner's Guide"
Title: The Concept of "Material Risk" in Informed Consent
The doctrine of informed consent has evolved significantly over the past century. Historically, the standard for disclosure was physician-based; a doctor was expected to disclose what a "reasonable physician" would tell their patient. This paternalistic model has been largely superseded by a patient-centered standard, crystallized in landmark legal cases such as Montgomery v Lanarkshire Health Board in the UK. This case established that the crucial question is not what a doctor thinks a patient should know, but what a "reasonable person in the patient's position" would consider significant to their decision.
This principle introduces the concept of "material risk." A risk is considered material if its disclosure would be likely to affect the decision-making of that particular patient. It is no longer sufficient to only disclose common risks. A physician must also discuss rare but serious complications, especially if they could have a devastating impact on the patient's lifestyle or livelihood. For example, a 1% risk of a stroke during a carotid endarterectomy is a material risk that must be disclosed, as a stroke could be life-altering.
Therefore, the process of obtaining consent must be a bespoke dialogue, not a generic recitation of a list. The doctor must make a conscious effort to understand what is important to the individual patient. For a professional singer, a small risk of vocal cord damage during thyroid surgery is a highly material risk. For an office worker, it may be less so. Failing to tailor the consent conversation to the patient's individual circumstances represents a significant breach of a doctor's duty of care.
Question: What is the central idea behind the principle of "material risk"?
Listening Task (Part A Simulation):
Scenario: You will hear a pre-operative assessment nurse confirming details with a patient from their signed consent form.
Task: Complete the notes on the checklist. Write one or two words for each gap.
Pre-operative Consent Checklist
Patient Name: (1)
Procedure: Left (2)
Confirmed understanding of:
- Potential benefits
- Significant risks
- (3) to surgery
Specific complications discussed:
- Infection
- (4)
Patient has given: (5) consent.
Part 4: Answer Key for Pre-Class Work
Reading Answer: c) A risk is significant if it is likely to influence that specific patient's decision to have the treatment.
Listening Answers: (1) Susan Hayes, (2) hip replacement, (3) Alternatives, (4) blood clots / DVT, (5) voluntary / informed
Part 5: In-Class Preparation
This section is designed specifically for doctors. Be prepared to discuss the vocabulary and practice the following tasks in class.
Speaking Task: OET Role-Play Card (Medicine)
Setting: A pre-operative assessment clinic.
Patient: A 65-year-old patient who has severe osteoarthritic pain. You are the surgeon.
Task (Obtain Informed Consent):
- Greet the patient and state the purpose of the consultation: to discuss their total hip replacement surgery in detail.
- Explain the potential benefits (e.g., pain relief, improved mobility).
- Explain the major risks and complications (e.g., infection, blood clots (DVT/PE), dislocation, leg length discrepancy).
- Explain the main alternative (continued non-operative management).
- Use the "teach-back" method to check their understanding before asking them to sign the consent form.
Writing Task:
You are the surgeon from the speaking scenario. After the consultation, you must write the formal "Consent" entry in the patient's medical record. It must clearly state that you have discussed the benefits, risks (listing the major ones), and alternatives, and that the patient has provided voluntary and informed consent.