To explore whether the fundamental concepts of informed consent and patient autonomy are acceptable and practical from a surgeon’s point of view.

One hundred and fifty three questionnaires distributed to Orthopaedic Surgeons in NZ were analysed statistically.

Seventy six percent of the surgeons guided their patients towards a particular procedure. Fifty five percent spent between 10% and 25% of their consultation time on obtaining informed consent. Forty eight percent of the surgeons felt that the patient did not have sufficient autonomy to choose to undergo a particular procedure, while 76% felt that it was impractical to offer all necessary information needed for that patient to choose the procedure.

Although the length of time that a surgeon had been in practice did not influence the practice of obtaining consent or his/her opinion of the patient’s self autonomy, the degree of his/her specialisation did (P< 0.05). There was no correlation between the time spent on obtaining consent and the degree of specialisation. There was a very strong correlation between the surgeon’s belief in patient autonomy, the practicality of offering all the necessary information and the method of obtaining consent (P< 0.0001).

The majority of Orthopaedic Surgeons in NZ do not believe it was practical to offer all the necessary information to a patient and to expect that patient to be fully autonomous in choosing to undergo a particular procedure. This indicates that it is time for re-evaluation of the practice of modern day informed consent based on its original concept.

To determine the outcome of Clavicle Hook Plate fixation in terms of level of function achieved, healing of the fracture and the need for removal of the hook plate.

Review of patient records and radiographs of all the fractured clavicles and acromioclavicular dislocations that were surgically treated with a Clavicle Hook Plate. The study population was identified using the operating theatre data.

A total of 24 patients (19 lateral third-Neer type II-fractures and 5 type III acromioclavicular dislocations) were treated from January 1998 to December 2003. Eighteen of the 24 plates (75%) had been removed at the time of the study. In 72% restriction of the range of movement and pain due to plate impingement were the main causes for removal of the plate. Two of the plates (11%) were removed due to ‘mechanical failure’; the plate being levered off the bone or eroding the acromion. Mechanical failure of the plate was significantly associated with an older age group (P=0.01).

At the time of discharge from the clinic 57% had more than 50% of their shoulder movements, while 55.5% had minimal or no pain.

We suggest that Clavicle Hook Plates should be routinely removed as they cause impingement symptoms and they be used with caution (if at all) in the older age group given the tendency for the plate to lever off the bone.

Our aim was to determine from the general community an understanding of the implications of informed consent, expectations in regard to self-autonomy, appreciation of risk in surgery, the implications of surgical complications, the degree of acceptability of risk for a given complication and views on surgeon liability.

One thousand questionnaires were distributed to members of the general public attending the Palmerston North Hospital as outpatients or visitors (inpatients were excluded).

Less than 20% of respondents appreciated the concepts of battery, negligence, self-autonomy and confidentiality. 59% wanted to know about potential complications in order to assist them in making a decision on whether or not to proceed with surgery. Given options and a discussion of the risks, 64% wished to take responsibility for which surgical procedure they would undergo. 9% were unaware that surgical procedures had risks of serious complications. 10% would not undertake surgery if the risk of a serious complication was one in a million, while 30% would undertake surgery regardless of the risk involved. 21% felt the surgeon would be liable in the event of an unmentioned rare complication.

The grasp of the perceived objective of informed consent is poor amongst the general population. The tolerance for medical negligence is low and expectations in regard to self-autonomy seem unrealistically high. We feel it is necessary to revisit ‘informed consent’ and for the public (and the legal profession) to make ‘informed consent’ a practical goal-orientated patient/doctor friendly process rather than the existing ‘legal obstacle’ that it is.