Patient education: All information & legal basis

Why do patients need to be informed?

Physicians must educate patients in order to preserve their right to self-determination and information. Patient education is intended to ensure that patients are well informed about their health conditions, treatment options, risks and potential consequences.

Furthermore, education is also important from a personal point of view in order to strengthen trust between doctor and patient and to increase patient satisfaction. Through proper education, doctors offer their patients an optimal basis for informed decision-making and active participation of patients in their own health management.

Brief overview: The legal basis of patient education

The obligation for doctors to provide information is set out in BGB §630c. It describes that the doctor has the duty to provide the patient with comprehensive information before starting treatment “all circumstances relevant to consent” to enlighten.

This sometimes includes:

• type
• scoping
• implementation
• Expected consequences and risks of the measure
• necessity
• urgency
• suitability
• Prospects of success with regard to diagnosis or treatment

As a result of many court rulings in recent decades, it has been worked out more and more precisely what patient education should look like (even in special cases). This is important for doctors to know so that they can minimise their legal risks on the one hand and adequately inform their patients on the other.

Now let's take a closer look:

The main principles of patient education (+ common questions)

1. Who must inform the patient?

In hospitals in particular, the question is often asked who is responsible for educating patients. This is because several treating doctors can be involved here. The education (in hospitals and medical practices) can either be provided by the attending physician himself or by a person who has the necessary training to carry out the medical measure.

It is not necessary for the person who is conducting the educational interview to carry out the actual action. This means that interns with appropriate training can also provide information.

If the doctor delegates the information to another doctor, the delegating physician is responsible for ensuring that the information is provided correctly. In the event of errors, both doctors may be held liable. When several specialist doctors with different areas of expertise are involved in the treatment, each specialist is responsible for educating the patient in their area of expertise. In the case of a surgical procedure, for example, there is information from the surgeon and also from the anesthetist.

2. The type of clarification

According to Section 630e (1) BGB, the doctor is obliged to Clarify all circumstances, which are essential for his consent. This includes:

• the diagnosis
• the planned course of treatment
• and the associated risks

However, it is important to note that the requirements for the scope of education must not be overstated. This means that the doctor must give the patient a general idea of the severity of the procedure and should highlight the biggest risks. However, there is no need for a comprehensive discussion of each individual risk. The patient should ultimately be able to understand what he is getting himself into. By the way, rare but serious risks should also be mentioned.

3. Individualized education

The same procedures or measures may pose different risks to different patients under different circumstances. For example, elderly patients who are already taking many medications may have particular risks that must be considered.

It is therefore important to always check whether additional precautionary measures are required due to medications or pre-existing conditions. This also applies to prescribing medicinal products, which should not only refer to the package leaflet.

4. The form of patient education: oral or written?

Patient information must be provided orally and can (optionally) also be documented in writing.

The oral explanation enables direct interaction between doctor and patient, which can clarify questions and ambiguities in real time. It also provides space for empathy and individual adaptation to the patient's needs.

Written education, on the other hand, provides a permanent record of information that the patient can read up later. It can be particularly helpful for conveying complex information in a comprehensible way and serving as a reminder for the patient. In addition, written clarification can help to document the scope and depth of the topics discussed.

A combination of both forms is definitely recommended, as the written version is not only used to improve patient information, but also to protect the doctor.

5. When must patient education take place?

Patient information must be provided in good time before a procedure in order to give the patient sufficient time to consider the pros and cons.

In particular during inpatient procedures It is usually too late to provide information on the day of surgery, as the patient must not be under pressure. Ideally, information should be provided days or weeks before major procedures or surgical recommendations.

‍For outpatient procedures The time of clarification depends on the case in question: In the case of low-risk procedures, this can be carried out on the same day, in the case of serious procedures at least one day in advance. It looks different for emergency patients off. Emergency patients who are admitted unconscious must be informed the day after the procedure.

6. How long is patient information valid?

There are no specific legal regulations in this regard. To be on the safe side, however, the following recommendation applies: In the event of an operation planned soon, which was clarified more than 3 months ago, the information should be refreshed again. This not only serves as legal protection for the doctor, but also helps the patient.

7. Does the doctor have to explain treatment alternatives?

In principle, it is up to the doctor to choose the most appropriate treatment method in accordance with medical standards. Explicit information about treatment alternatives is not always necessary, unless there are comparable methods with significant differences in risks or burdens for the patient. In such cases, the doctor must explain the alternatives and their advantages and disadvantages. When choosing an unconventional method, there are higher educational requirements and care must meet the standards of a careful doctor.

‍Here, too, the following applies to emergency patients: In the case of unconscious or emergency patients, the information requirements are generally reduced the more urgent an intervention is required.

8. Documenting patient education: Mandatory? If so, how long do they have to be kept?

Documenting patient information is not a legal obligation. It serves primarily as a reminder for the doctor and as proof for the patient that the information has been provided.

‍However, it is important to note: In recent years, legal requirements and liability risks for doctors have increased, which is why we recommend that all doctors document patient information in writing, even if this is not required by law.

‍Because the fact is: The doctor bears the burden of proof for proper information. The use of clarification forms is expressly supported by the Federal Court of Justice.

Documentation (and patient education in general) can be done both physically and digitally, which has several advantages:

Digital patient education for doctors

Die digital patient education provides a legally compliant alternative to traditional paper-based education. According to legal regulations, it is allowed to digitally educate patients without physical documents or the need for handwritten signatures.

According to some voices in legal literature, digital documents for patient education even have equivalent or higher evidentiary value than handwritten documentation. Digital development in this area is also supported by legislative initiatives such as the Fourth Bureaucracy Relief Act (BEG IV), which promotes the electronic form in the Civil Code.

Services like Nelly offer digital educational forms that are customizable, clear and efficient, thus improving the patient experience and facilitating communication between doctor and patient.

Special cases in patient education

1. Patient education for minors

The consent of minors to medical treatment is determined not only by their status of majority, but in particular by their mental capacity to understand and make decisions. If a minor is able to understand the significance of their decision, they can themselves (in the case of non-serious or high-risk procedures) consent to treatment. In such cases, the doctor must educate the minor and not necessarily involve the parents. There are no fixed age limits, but In general, children under 14 years of age are not able to give effective consent, while adolescents are usually capable of giving consent shortly before their 18th birthday.

The assessment of consent capacity depends on various factors, including the urgency of treatment, risks, and potential consequences. If a minor is incapable of giving consent, parental consent is required. Exception: It is an emergency where hypothetical consent is assumed.

‍Important: In the case of high-risk procedures, the doctor must inform both the parents and the minor, and in the case of serious procedures, the consent of both parents should be obtained.

2. Patient education for foreign-language patients

Educating patients who speak another language can be a challenge.

Because the following applies: Patient consent is only legally recognized if the patient fully understands the information.

That means: The doctor must conduct the interview in accordance with the patient's individual language comprehension and take into account special features. As I said: If there are problems of understanding and effective communication is not possible, consent would be legally ineffective.

In such situations, the doctor must either refuse treatment or arrange for an appropriate interpreter. It is not enough simply to provide the patient with a foreign-language information sheet, although, for example, a person working in a hospital with appropriate language skills can act as an interpreter.

If the patient clearly does not understand the information, treatment should therefore usually be postponed. As is often the case, there is one exception: It is a medical emergency.

By the way: If the foreign-language patient brings in an interpreter, he will bear the costs himself. However, the doctor should point this out to him beforehand.

3. Patient education during cosmetic surgery

A relatively simple principle applies here: The less necessary an intervention is from a medical point of view, the more detailed patient education should be. This means that information should be very comprehensive for pure cosmetic surgery. Risks and opportunities for success must be communicated honestly so that the patient can clearly see what they are getting themselves into.

Tip: Use digital dental education forms from Nelly

Nelly offers dental information sheets for your practice. Your benefits:

• Maximum customization at the push of a button: Design your information forms quickly and intuitively. Regardless of whether it is the material, the affected region or a specific tooth — you determine what is relevant.
• Fully digital: Notes and drawings could also be digitally included in the explanatory forms.
• Clear and transparent preview: Before final approval, you and your patients can review the forms in a clear preview. This ensures maximum precision and patient satisfaction.
• Digital efficiency: All relevant information, such as the time of the procedure, procedure and medical notes, is recorded digitally and can be retrieved at any time.
• Improved patient experience: Together with your patients, you can digitally go through and explain all aspects of treatment — from side effects to rules of conduct before and after the procedure.
• Seamless communication: With just one click, the forms can be sent to the patient via SMS or email. Simple, efficient and uncomplicated.
• Easy access for everyone: The documents can be viewed at any time via both the doctor and patient portals. This promotes trust and transparency in your practice.

Get free advice on Nelly's digital dental information forms now!

synopsis

In recent decades, it has been shown that both case law and legislators are setting ever stricter requirements for doctors. This is intended to ensure that patients are adequately informed about their treatment as part of patient education. Despite increasing burdens and time constraints for doctors, it is crucial to take patient education seriously and to carry it out thoroughly.

With providers such as Nelly, doctors can make patient education more efficient and at the same time improve the quality of information and the patient experience in accordance with legally compliant standards.

The personal names used in this article always refer equally to all persons. Dual naming and alternate names are omitted in order to improve readability.