'There is a small risk of infection' does no work. The patient cannot weigh it, cannot compare it against the alternative of not operating, and cannot later say they were told. Worse, the same phrase covers a risk that varies by a factor of eighty between the operations on your list.
Say the frequency instead, as a natural number, and say it for the operation you are actually doing. One in about 2,650 for adult cataract surgery. One in about 1,000 for trabeculectomy. One in about 106 for an open globe repair. Add what it means - that endophthalmitis is treatable but can cost the eye - and what you do about it, which is the povidone-iodine, the drape and the postoperative drops.
Then write the number in the notes. A documented figure is worth more at a later complaint than a page of printed generic consent, and it is the only version of this conversation that tells the next clinician what the patient was actually told.
- Quote the frequency for the specific operation, as one in N, not as 'small' or 'rare'
- Use a higher figure for children having cataract surgery than for adults - the rate was about three times higher
- Say what endophthalmitis means for the eye, not only that it can happen
- Name the prophylaxis you use, so the patient knows the risk is being managed rather than accepted
- Record the number you quoted in the operation note or consent record
Why it matters
The same phrase is used for a one-in-106 risk and a one-in-9,000 risk, which makes it useless to the person deciding.
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