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A survey of the current practice of the informed consent process in general surgery in the Netherlands

Wouter KG Leclercq1*, Bram J Keulers2, Saskia Houterman3, Margot Veerman4, Johan Legemaate5 and Marc R Scheltinga1

Author Affiliations

1 Department of Surgery, Máxima Medical Centre, de run 4600, Veldhoven 5504 DB, the Netherlands

2 Department of Plastic Surgery, Bernhoven Hospital, Burgemeester de Kuijperlaan 7, Veghel 5461 AA, the Netherlands

3 M.M.C. Academy, Máxima Medical Centre, de Run 4600, Veldhoven 5504 DB, the Netherlands

4 Department of Surgery, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, Nijmegen 6532 SZ, the Netherlands

5 Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands

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Patient Safety in Surgery 2013, 7:4  doi:10.1186/1754-9493-7-4

Published: 21 January 2013



A properly conducted surgical informed consent process (SIC) allows patients to authorize an invasive procedure with full comprehension of relevant information including involved risks. Current practice of SIC may differ from the ideal situation. The aim of this study is to evaluate whether SIC practiced by Dutch general surgeons and residents is adequate with involvement of all required elements.


All members of the Dutch Society of Surgery received an online multiple choice questionnaire evaluating various aspects of SIC.


A total of 453 questionnaires obtained from surgeons and residents representing >95% of all Dutch hospitals were eligible for analysis (response rate 30%). Knowledge on SIC was limited as only 55% was familiar with all three basic elements (‘assessment of preconditions’, ‘provision of information’ and ‘stage of consent’). Residents performance was inferior compared to surgeons regarding most aspects of daily practice of SIC. One in 6 surgeons (17%) had faced a SIC-related complaint in the previous five years possibly illustrating suboptimal SIC implementation in daily surgical practice.


The quality of the current SIC process is far from optimal in the Netherlands. Surgical residents require training aimed at improving awareness and skills. The SIC process is ideally supported using modern tools including web-based interactive programs. Improvement of the SIC process may enhance patient satisfaction and may possibly reduce the number of complaints.

Informed consent; Surgery; Patient education; Questionnaire; Interactive tools; Training