Editor,—The phrase “informed consent” falls so readily from the pen that it is easy to forget that two distinct processes are involved: firstly, providing appropriate information and then obtaining consent from the patient. In attempting to combine these two steps, Shepherd and colleagues ((2000) Gut 46:37–39; ) remove some of the patients' essential safeguards. As Neale ((2000) Gut 46:5–6.OpenUrlAbstract/FREE Full Text) points out in his gentle and thoughtful comment, “written information . . . is undoubtedly useful but it does not replace the over-riding need for doctors to speak with their patients . . .”.

Neither the paper nor the commentary cite the GMC advice1although they are quoted extensively in the British Society of Gastroenterology guideline on informed consent for endoscopy procedures.2 Particularly relevant is this: “obtaining informed consent cannot be an isolated event. It involves a continuing dialogue between you and your patients . . . you should give . . . the patient time to ask questions”.

However carefully prepared, a booklet cannot be appropriate for every patient and every circumstance. Pressing patients to “sign consent” in advance of meeting any endoscopy staff is to deprive them of the opportunity to ask questions or seek reassurance. “If you are the doctor . . . undertaking an investigation it is your responsibility to discuss it with the patient …”2although the job may be delegated to an appropriate person.

Giving information by post is desirable: requesting signed consent by that route is not.

Editor,—Shepherd and colleagues ((2000) Gut 46:37–39.) offer a timely and thoughtful contribution to the increasingly loud debate within …