Editorial: Recommendations of the Assistance Publique des Hopitaux de Paris, AP-HP (Paris Public Hospitals Group) France: The role of medical and non-medical staff in providing information to patients (from the report by Professor Paul Legmann).

The 20 key points of the AP-HP document (Assistance Publique des Hopitaux de Paris) 1) Hospital doctors must provide health care recipients with information in compliance with standards laid down by the medical code of ethics. 2) Radiographers and nursing staff must contribute to the provision of information within the framework of their assigned responsibilities and in compliance with their professional rules. 3) Doctors must draft prescriptions clearly, ensure that the patient and immediate family circle understand them and encourage compliance. 4) Doctors have a duty when examining, treating or advising to provide clear, appropriate and fair information regarding the patient's condition and the investigations and treatment proposed. During the course of the illness, physicians must take into account their patients' individual personalities when providing explanation and ensure these are understood. 5) Unless the condition places others at risk, a particularly grave diagnosis or prognosis may be withheld from a patient if the doctor, in good faith and for legitimate reasons, believes this to be in the best interests of the patient. 6) A patient should be informed of a fatal illness only after due consideration by the physician. Close relatives must always be informed, however, unless the patient has previously forbidden this or designated third parties to impart the information. 7) When several doctors collaborate on a diagnostic or treatment procedure, they must keep each other updated on the case. Each practitioner shall assume personal responsibility and inform the patient within the realm of his/her competence. 8) Oral information is priority and must be clear, fair, understandable and ordered. 9) The duty to inform is continuous. Consistent and constant information must be provided at all stages and, where possible, by the same physician. 10) Information must be provided on the benefits expected from a procedure and possible serious attendant risks, however exceptional. 11) Where possible, the practitioner should always verify that the information imparted has been properly understood. 12) It is recommended that: - hospital doctors accompany oral information with printed leaflets where these aid understanding; - departments set down a list of those invasive procedures requiring information leaflets. This practice will also help to standardise presentation of the risks and benefits. 13) Patients should not be requested to sign information sheets. 14) It is recommended that for each patient, one member of the medical team be designated, with responsibility for informing the patient and close relatives. 15) On patient admission, details of the family members to be informed must be systematically collected. Similarly, parents or guardians must be systematically contacted on the admission of children. 16) What information is to be given the patient and close family must be discussed by the medical group and the decisions taken recorded in the patient's file. 17) Each department shall define rules on giving information over the telephone to the family or immediate circle. These rules must be set down in writing and understood by all staff concerned. 18) Any information given to the patient must be noted in the medical file. It is to be presumed that only the details noted have been communicated. In this way, the patients' medical record serves as a communication tool for the various members of the medical team regarding the information given to the patient. 19) Obtaining written patient consent (permission to operate and similar documents) is neither compulsory nor recommended, except where required by law. The law demands that written consent be obtained for the following: biomedical research, fertility treatment, termination of pregnancy, genetic research, harvesting of organs from a living donor, certain organ harvesting from a deceased person, surgical procedures on a child. 20) In the event of litigation centring around failure to inform, no evidence, not even written evidence, is a watertight guarantee that the doctor has fulfilled his obligation. Whether information has been correctly imparted or not will be assessed on the basis of a range of elements such as: the period allowed the patient to take an informed decision, the number of visits, practitioners consulted before proceeding, the systematic provision of information leaflets and the notes made on the patient record.