GMC: Decision making and consent: Summary

SJT Textbook: Decision Making and Consent

GMC Decision Making and Consent

This GMC decision making and consent guidance explains how doctors must involve patients in decisions, assess capacity, disclose material risks, respect refusals, and act in best interests where capacity is lacking.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Decision making and consent sit at the heart of ethical and lawful medical practice. Patients have the right to be involved in decisions about their care, to receive information they need to decide, and to have their values and preferences respected. Consent is not a signature or a single moment; it is an ongoing process of shared understanding.

The guidance applies to all health decisions, including investigations, treatment, screening, referrals, and remote consultations. Doctors must presume capacity in adults unless proven otherwise, support patients who lack capacity to decide, and act in their best interests where legal frameworks apply.

In the MSRA SJT, high-scoring answers show clear communication, proportional information-sharing, respect for autonomy, accurate documentation, and appropriate escalation when capacity or voluntariness is in doubt.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Involve the patient actively in decisions about their care.
2. Explain material risks, benefits, and alternatives clearly and honestly.
3. Check understanding and invite questions.
4. Explore the patient’s values, priorities, and preferences.
5. Presume capacity in adults unless there is evidence otherwise.
6. Assess capacity carefully when it is in doubt.
7. Act in the patient’s best interests when they lack capacity.
8. Use interpreters and communication aids when required.
9. Review decisions over time as circumstances change.
10. Document the discussion and the decision clearly.

According to GMC decision making and consent standards, patients must be fully informed before any treatment proceeds.

These traps minimise autonomy, ignore capacity principles, or rely on paperwork over proper dialogue.

The GMC decision making and consent framework applies equally to face-to-face and remote consultations.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I will check the patient’s understanding before proceeding.”
* “I must assess capacity before making this decision.”
* “I will involve the patient in line with their wishes.”
* “I will act in the patient’s best interests where capacity is lacking.”

For the MSRA SJT, GMC decision making and consent questions regularly test capacity assessment and refusal of treatment.

C – Capacity
O – Options explained
N – Needs and values explored
S – Shared decision
E – Explicit understanding checked
N – Notes documented
T – Time to review

📋 QUICK FAQ

Is consent always required?
Yes, for all examinations, treatments, and investigations unless urgent lifesaving action is required. Is a signed form enough?
No. Consent is a process of dialogue and understanding, not just documentation. What if the patient lacks capacity?
You must act in their best interests using the legal framework and involve appropriate others. What if the patient refuses treatment?
A competent patient has the right to refuse, even if the decision seems unwise. Does this apply to remote consultations?
Yes, the same consent standards apply.

Errors in GMC decision making and consent usually involve coercion, poor documentation, or failure to assess capacity.

📚 GMC ANCHOR POINTS

• Shared decision making – Decision Making and Consent (2020)
• Presumption of capacity – Decision Making and Consent
• Best interests – Mental Capacity framework
• Clear communication – Good Medical Practice
• Documentation – Record keeping standards
• Proportionate information-sharing – Decision Making and Consent

💡 MINI PRACTICE SCENARIO

A competent adult refuses a recommended investigation despite understanding the risks. Best action: Respect the refusal and document the discussion clearly. Why: A competent patient has the legal right to refuse treatment.

🎯 KEY TAKEAWAYS

✓ Consent is a continuous dialogue, not a form
✓ Patients must be informed and involved
✓ Capacity is presumed unless shown otherwise
✓ Best interests apply only when capacity is lacking
✓ Communication must be clear and tailored
✓ Decisions must be documented accurately

Every doctor must follow GMC decision making and consent guidance when discussing risks and alternatives with patients.

🔗 RELATED TOPICS

* → Capacity and Best Interests
* → Confidentiality and Information Sharing
* → Safeguarding Adults
* → Professional Boundaries
* → Remote Consultations

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A patient is anxious about a proposed procedure and asks if they can think about it overnight. The procedure is important but not urgent.

Options:
A. Proceed immediately to avoid further delay
B. Encourage questions and address concerns
C. Provide written information about risks and benefits
D. Ask the family to decide on the patient’s behalf
E. Document the discussion and defer the decision
F. Pressure the patient to consent for their own good
G. Tell them refusal is not an option
H. Remove the option of declining

Example SJT — Rank 5 (best → worst)

An adult patient refuses a blood transfusion on religious grounds.

Options:
A. Respect the refusal and document clearly
B. Explore understanding and alternatives
C. Seek senior advice if unsure
D. Proceed anyway for safety
E. Ignore the refusal