OR14.1-2 | Orthopaedic Prognosis and Consent Counselling — Summary & Reflection

KEY TAKEAWAYS

This module has developed your competence in two interconnected skills: orthopaedic prognosis counselling and valid informed consent. The four orthopaedic contexts requiring structured prognosis conversations are fractures with residual disability, conditions requiring prolonged immobilisation, bone tumours, and congenital disabilities. Valid informed consent requires simultaneous presence of decision-making capacity, adequate disclosure, voluntariness, and proper documentation — absence of any single element invalidates the consent legally and ethically. The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotion, Strategy) provides the evidence-based scaffold for difficult prognosis conversations. Specific adaptations for orthopaedic scenarios include quantifying functional limitations in language the patient understands, addressing the irreversibility of amputation explicitly, managing parental guilt in congenital disability discussions, and using teach-back to verify comprehension. Recognising and responding to the five patient response patterns (denial, anger, bargaining, sadness, withdrawal) transforms a unidirectional information delivery into a therapeutic communication encounter. Documentation of the consent process — naming the specific procedure, the material risks disclosed, the patient's questions, and the clinician's responses — is both an ethical obligation and an essential medicolegal protection.

REFLECT

Think back to any clinical encounter you have observed — or perhaps experienced as a patient or family member — where bad news or a difficult medical decision was communicated poorly. What specifically was missing? Was it the setting (wrong place, wrong time), the content (information that was unclear or incomplete), the emotional register (rushed, dismissive), or the follow-up (no clear next step)? Now imagine you are the orthopaedic registrar who must tell a 28-year-old professional footballer that his osteosarcoma requires above-knee amputation. Using SPIKES as your structure, draft in your mind the first three steps of that conversation — what would you say at each stage? What would you watch for in the patient's face? How would you close the meeting? Reflect on what you would find most difficult about that conversation and what preparation would help you manage it.