title: Surgery in an Afghan population: is pictorial consent and injury pattern recognition identification of patients appropriate?
abstract: OBJECTIVE
  The aim of this study was to develop a safe way to obtain informed consent and ensure the correct patient was operated on in a generally poorly educated, non-English speaking Afghan patient population admitted to a military role 2 (enhanced) hospital facility.
  
  
  BACKGROUND
  Prior to Herrick 9, surgical consent for Afghan patients was obtained via an interpreter in the traditional manner and documented on a U.K. formatted consent form (MOD form 660) (group 1) with patient identification largely being the responsibility of the interpreter. Patient agreement was documented by placing a thumbprint on the form. During Herrick 9, pictorial consent and injury pattern recognition (IPR) identification of patients was introduced. The consent was written as part of the case note narrative with diagrammatic representation of the injuries and the proposed surgery, which was explained by the interpreter (Group 2).
  
  
  METHODS
  We compared the consent and identification process for ten consecutive patients from each group. Each method of consent was examined for documentary evidence of the procedure, patient identification and method of patient agreement. The senior Afghan interpreter was asked for his personal views on the benefit or otherwise of the pictorial consent.
  
  
  RESULTS
  For group 1, each of the nine MOD form 660s were completed in English by the operating surgeon and included details of the procedure. Seven had been signed by the interpreter. Each had a thumbprint on the form but there was no name or date alongside it. There was no way of confirming that the thumbprint was that of a particular patient. For group 2, pictorial consent was documented in the narrative with specific documentation of the injury pattern of that patient. Confirmation of consent and patient identification by IPR was by the operating surgeon.
  
  
  CONCLUSIONS
  When possible, informed consent is required for all patients undergoing surgery in line with Department of Health guidelines. The use of pictorial consent and IPR identification, as part of patient documentation, would appear to be superior in this particular environment.
authors: Royal Navy, Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham.
authors: A S
authors: AS
authors: Matheson
authors: R D
authors: RD
authors: Howes
authors: M J
authors: MJ
authors: Midwinter
authors: A W
authors: AW
authors: Lambert
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001296:Audiovisual Aids; D003142:Communication; D006801:Humans; D007258:Informed Consent; D008887:Military Medicine; D014947:Wounds and Injuries / Q000601:surgery