Outpatient hysteroscopy/biopsy - RCOG Patient Information Leaflet

Response to this request is long overdue. By law, under all circumstances, Isle of Wight NHS Trust should have responded by now (details). You can complain by requesting an internal review.

Katharine Tylko-Hill

Dear Isle of Wight NHS Trust,

Outpatient Hysteroscopy/Biopsy – RCOG Patient Information Leaflet

Further to the information your Trust supplied stating that you are not using the RCOG Outpatient Hysteroscopy patient leaflet, and further to the CQC's recommendation that you update your gynaecology patient information leaflets,

1. Please has your Lead hysteroscopist read the Montgomery v. NHS Lanarkshire ruling on informed consent? [Y/N]

https://www.supremecourt.uk/cases/docs/u...
“The doctor is under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in proposed treatment, and of reasonable alternatives. A risk is “material” if a reasonable person in the patient’s position would be likely to attach significance to it, or if the doctor is or should reasonably be aware that their patient would be likely to attach significance to it.”

2. Please has your Lead Hysteroscopist read the RCOG guidance on consent https://www.rcog.org.uk/globalassets/doc...

“Women should not be given important information or asked to make decisions at the same time as undergoing gynaecological examinations.7
In the modern NHS, efficiencies such as placing patients directly onto waiting lists and admitting patients to hospital on the day of operation require careful attention to the organisation of consent. These initiatives have the potential to shorten or even eliminate the ‘cooling-off’ period during which a woman is able to reflect on her condition and the proposed treatment options. If written consent in the presence of the operating practitioner is to be obtained immediately before the operation, it is vital to ensure that she has been offered the opportunity to further discuss any intervention in a clinic visit or a visit to a preoperative assessment unit. If not, and women are being presented with information anew for the first time or are doubtful, deferral must be retained as an option in the best interests of patient care even if it means that their procedure is postponed. Such women should also be sent detailed information packs with a copy of the appropriate consent form.” [Y/N]

3. Please has your Lead Hysteroscopist read the RCOG Outpatient Hysteroscopy patient information leaflet https://www.rcog.org.uk/en/patients/pati... which warns of the material risk of severe pain; identifies cohorts of patients at high risk of severe pain; and advises women that they may choose to have a general anaesthetic? [Y/N]

“Are there alternatives to having outpatient hysteroscopy? There may be other things to consider when deciding whether OPH is the right choice for you, such as:• if you faint during your periods because of pain• if you have experienced severe pain during a previous vaginal examination• if you have experienced difficult or painful cervical smears• if you have had any previous traumatic experience that might make the procedure difficult for you• if you do not wish to have this examination when awake. You may choose to have your hysteroscopy with either a general or spinal anaesthetic. This will be done in an operating theatre, usually as a daycase procedure. You can discuss this option with your healthcare professional. The risks and complications are lower when hysteroscopy is done as an outpatient procedure rather than under anaesthesia.”

4. Does your Trust now intend to start using the RCOG Outpatient Hysteroscopy patient information leaflet, and if so, when? [Y/N]

5. If the answer to Question 4. is NO, please why is this? Is it because
a) You run a See & Treat clinic and the patient may not need a hysteroscopy [Y/N]

b) You don’t want to mention severe pain and make patients anxious? [Y/N]
c) You don’t want patients to choose GA because it will affect your hysteroscopy Best Practice Tariff? [Y/N]
d) You don’t want to put patients through the higher risk of perforation under GA due to use of wider hysteroscopes? [Y/N]
e) You don’t want to give patients the choice of GA because there is a long waiting-list which will delay cancer diagnosis [Y/N]
f) You don’t have the budget to print out a new, longer leaflet? [Y/N]
Any other reasons ... please specify.

With many thanks for your help in improving the early diagnosis of womb cancer.

Yours faithfully,

Katharine Tylko-Hill

Freedom of information, Isle of Wight NHS Trust

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