Dont assume it is easy for patients to say No

This week’s ‘What your patient is thinking’ in the BMJ describes what it was like when someone who had been ‘in care’, Aine Kelly, started to access healthcare again.

In her six-monthly hospital health assessments, Aine was expected to strip down to her underwear and perform various tasks like standing on one leg. This was after her childhood physical abuse (though the health assessments sound pretty close to some sort of abuse to me!).

In her article, Aine gave some great advice to doctors. Please read it!

But what I wanted to highlight, and discuss, was her first point:

When you ask for consent, don’t assume that it is easy for me to say no. Explain your reasoning, and let me know you won’t criticise me if I refuse.

Aine had her own specific reasons for this. But I think her point is much more widely valid. I have myself usually asked for consent with an ‘Is it OK?’ type question.  This presumes that the answer is ‘Yes’. And definitely puts the onus on the patient to say ‘No’.

Maybe her advice could be changed a little – to put the explaining first, then the letting know it’s OK to say no – and only after that, any asking for consent?

And maybe the BMJ illustration, shown here above, might more realistically have a little girl looking slightly less happy?!





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