Submitting to surgical procedures is an inescapable part of treatment regimen for many conditions. Whether it is severe disorders of the abdominal parts such as stomach, pancreasand gall bladder,etc., requiring general surgery, or gynaecological conditions requiring specialized surgery, or endocrine disorders, or orthopaedic, ophthalmologic, or neurological conditions, each of thesebesides many others require a specialized surgical intervention. In other words, a surgical procedure becomes an inevitability in the course of treatment for many diseases. Given the innate sensitivity of any surgical procedure, obtaining informed consent constitutes an integral part of the whole process. With India bearing a high disease burden and the accompanying need for high number of surgeries,the country has a mammoth requirement of modern informed consent solutions.
Estimates of need for surgery in India
According to Lancet commission on Global surgery, there is a need for 5,000 surgeries per year per 100,000 people in lower middle income countries (LMICs). India is an LMIC as classified by the World Bank. Looking at it differently, in an estimate, 11% of global burden of disease requires surgical care or anaesthesia management, or both, with some studies calculating this burden to be as high as 30 percent.That India has a high disease burden cannot be questioned. A Springer study has estimated that as many as 3,646 surgeries per 100,000 population are needed to meet the surgical needs of the Indian population. Another India-based study (without accounting for the paediatric population) has estimated that 2,650 individuals needed surgery among 100,000 adults in India.
The sheer number of surgeries conducted in the country
In an estimate for the year before Covid-19 struck India, a staggering two crore surgeries had been conducted in the country in a single year. And of these, 80 lakhs were general surgeries, followed by50 lakh gynaecological surgeries, 70%of which were C-sections. Oncology, cardiology,neurology, orthopaedic and gastro-intestinal surgeries were recorded at 10 lakh each. The year before, in 2018, in a world record, AIIMS, the country’s premier hospital alone had conducted 1.94 lakh surgeries. However, in the immediate aftermath of the Covid-19 outbreak, there was a precipitate decline in elective and non-emergency surgeries in the country. By May 2020 itself, there were reports of more than 5.8 lakh elective surgeries having been delayed or cancelled in the country due to the pandemic.In fact, the authorities in several states and districts had to direct that the surgeries be kept on hold in order to ensure that Covid-19 patients received utmost attention and care. However by January 2021, surgery numbers had again picked up, reaching 80-85% ofpre-Covid-19numbers.While these numbers would have again waxed or waned depending on the severity of Covid-19 situation, there can be no doubt on the colossal market size for surgeries that exists in the country. And this in turn implies the extent of the requirement and potential for informed consent solutions.
All surgeries require informed consent
Contrary to the popular perception that only major surgeries and those addressing life-threatening conditions require obtaining of informed consent, the truth is that even seemingly very harmless and minor operations too necessitatethis. So, whether elective or routine, or emergency surgeries to treatgrave,life-threatening conditions, all surgeries call for informed consent.At the same time, we must remember that many elective surgeries are time-sensitive,which means that ifthey are postponed for an unduly long time, the condition of the patient can deteriorate and even turn life-threatening.
How modern consent solutions differ from traditional ones
Before a doctor proceeds with an operation, he mustexplain in detail the whole procedure, the risks and benefits, and even the risks of not opting for a procedure. So, it is expected and indeed mandatory that the doctor or the hospital obtains the consent of the patient or family members. For his part, the patient must have the capacity to broadly understand the process and the consequences. And all this needs to be documented. However, unlike the traditional paper-based and rather rudimentary consent process which often entails one-way communication and exchange of sketchy information, today’s modern informed consent solutions are completely digitalized two-way communication platforms enabling a more detailed and elaborate exchange of information between the doctor and the patient. Not only are they user-friendly, but are also available in simple and easy-to-understand language, making it worthwhile for everyone, including the doctors, the hospitals and of course the patients. As such, they address the cause of patient education while also minimizing the possibilities of unnecessary post-operative lawsuits against doctors and hospitals.
Now that the omicron wave of the Covid-19 pandemic has shown signs of ebbing, there is every likelihood of cases of routine and elective surgeries, which had been kept on hold due to the pandemic, would again appear in extraordinary numbers. While traditionally serious and lifesaving surgeries along with C-sections would continue to drive the demand for informed consent solutions, propelled by an increase in discretionary income, modern lifestyle changes would also give an impetus to surgeries for weight loss or plastic and reconstructive surgeries, or many other ‘milder’ conditions. Thisagainwould trigger a high demand for modern informed consent solutions in the country.
By- Dr. Nitendra Sesodia Senior Director Medical Communication & Corporate sales Thieme
