A signature is not consent. Consent is the set of things you could say back afterwards — and the form usually arrives in the last two minutes, when there is no time left to find out which of them you are missing.

What you are holding, and what is still empty

Mark each piece honestly. The tool sorts them into the ones you hold, the ones that were explained and did not stay, and the ones nobody has raised — then gives you the question for each gap and the sentence that buys the time to ask it. Nothing is saved and nothing leaves the page.

How the conversation goes wrong, when nobody is doing anything wrong

• The form arrives at the end. The explanation happens in the middle of the appointment, the signature at the door, and the two get remembered as one event. By the time the paper is in front of you the questions you would have asked have been crowded out by the ones about parking and dates.
• The person explaining is often not the person operating. That is normal and usually fine, but it means "he explained it all" and "I have discussed it with my surgeon" are different statements, and only one of them can answer who will actually be holding the knife.
• Risk gets said in words, not numbers. "Small risk", "rare", "very unlikely" are honest attempts at a figure that exists somewhere. One in a hundred and one in ten thousand are both described that way, and they are not the same decision.
• Doing nothing is almost never presented as an option. Not from dishonesty: the clinic exists to treat, the referral was made because somebody wanted something done, and the untreated course is the one thing nobody in the room has a leaflet for. It is still half the comparison.
• Success is defined technically. An operation can go perfectly and leave the symptom that made you come. Ask what will still be wrong afterwards; the answer is often surprising and almost never volunteered.
• Fear does the remembering. People retain the first thing and the frightening thing and lose the middle, which is where the practical detail lives. That is why saying it back matters more than listening harder.

The five pieces the decision rests on

• What it actually is, in words you could repeat to a friend. If the sentence you would use contains a term you would have to look up, you do not have this yet.
• Why now, and how they know. Which of your symptoms is this meant to fix, and how was the finding on the scan matched to what you are feeling? Findings that are common in people with no symptoms are common in people with symptoms too.
• What doing nothing looks like, over a stated period. Sometimes it is grim and hearing so makes the decision easy. Sometimes it is "much the same for years", and that changes everything about how fast you need to decide.
• The harms, as numbers, for somebody like you. Common problems and serious ones, in cases per hundred or per thousand. Age, weight, smoking, diabetes and heart or lung disease all move these, so a general figure is a starting point rather than your figure.
• What happens if it does not work. Can it be redone, does the second attempt work as well, and does this close a door — a joint that cannot be replaced twice as successfully, tissue that cannot be operated through again easily. Reversibility is part of the price.

Getting a number instead of a word

• Ask "out of a hundred people like me". It is the phrasing most likely to produce an actual figure, because it asks for something a clinician can answer from what they know rather than from a leaflet.
• Ask for both sides in the same units. The chance the operation helps and the chance it harms, both as cases per hundred or per thousand, over the same period. A benefit given as a percentage against a harm given as "rare" cannot be weighed at all.
• Ask whether the figure is for people like you. Trial populations are often younger and healthier; the surgeon's own numbers are often better than the published average for reasons that may or may not apply to you. Either way it is a fair question.
• "We have not measured that" is a real and useful answer. It is different from "it is rare", and it tells you where the uncertainty actually sits. Nobody should be embarrassed to say it and you should not be embarrassed to ask.
• Write the two numbers down while you are in the room. Figures remembered from a consultation drift, and the drift is always in the direction of whatever you were already feeling.

Who, where, and which anaesthetic

• Ask who will do it. "Will you be doing this yourself?" is an ordinary question with an ordinary answer. Trainees operating under supervision is how surgeons are made and the outcomes are not generally worse, but you are entitled to know the arrangement rather than to assume one.
• Ask about the anaesthetic separately. General, spinal or local changes the day, the recovery and the risks, and the person who will decide it may be somebody you have not yet met. If you have had a bad reaction before, or a relative has, say so before the morning.
• Ask day case or overnight, and what happens if you are not well enough to go home. Being sent home the same day is usual and good; being told at four in the afternoon that you cannot go home to an empty house is a solvable problem a week earlier.
• Ask what is being done to prevent the predictable problems — clots, infection, the tube in your bladder, the antibiotic at the start. Not to check up on anybody, but because knowing the plan is what lets you notice when something has been missed.
• Get the side or the site named in writing. Wrong-site surgery is rare and the systems that prevent it depend partly on the patient confirming. Being the last check in the chain is a reasonable thing to be asked to be.

Saying not yet, and changing your mind

• "Not yet" is not "no". It is the sentence this whole page is for, and it is almost never met with hostility. If it is, that has told you something useful about the rest of the care.
• Asking does not usually cost you your place. In most systems a slot deferred once is not a slot lost, and where it genuinely is, that is a fact worth knowing before you decide rather than after.
• Consent can be withdrawn. Up to the moment it starts, and for the later stages of anything staged. A signature is a record of a conversation, not a contract you are trapped in.
• You can ask for the conversation to be repeated. "Can I say back what I understood and you correct me" takes ninety seconds and is the highest-value sentence in the appointment. It moves the burden onto the explanation, which is where it belongs.
• You can ask for time without a reason. "I would like to think about it until Friday" is a complete sentence. You are not required to justify wanting to understand a decision about your own body.
• Say it out loud if you feel you cannot ask. That sentence — "I feel like I am being difficult" — changes almost every consent conversation it is said in.

Deciding for somebody who cannot

• Check who holds the authority and whether it has come into effect. Authority over money is not authority over health decisions, and the two are usually separate documents with separate triggers. If nothing is in place, ask what the process is where you are rather than assuming a spouse or a child can simply decide.
• Capacity is decision-specific and can fluctuate. Somebody who cannot manage their finances may be perfectly able to say whether they want an operation. Ask for the decision to be explained again, at a better hour of the day, before concluding they cannot make it.
• The standard is what they would have wanted, not what reassures the family and not what a clinician would choose. Earlier words count, especially written ones, and so does anything they said about how they would want to live rather than only about treatments.
• Ask for a best-interests discussion to be recorded. Who was consulted, what was decided, and why. It protects the person, and it protects you from carrying an unrecorded decision alone.
• Emergency treatment is a different situation. Where somebody cannot consent and waiting would cause serious harm, clinicians can and should act without waiting for the family. That is not a failure of consent; it is what consent law is built to allow.

What people believe, and what is so

The drill: 16 conversations

Sixteen ordinary appointments — the form at the door, the trainee, the word "rare", the scope that might become a removal, the relative asked to translate. Most have a polite answer that feels cooperative and leaves you signing something you cannot describe. Pick your move; every answer explains why.

The card

Print it and take it in. The first line is the whole of it.

🖨️ Print the card