Question 1

What has to be discussed before an injection?

Accepted Answer

The working diagnosis and why an injection is proposed, what the procedure involves, the expected benefit including that it may be partial and short-lived, the material risks, the reasonable alternatives including continued rehabilitation and taking no action, and the aftercare and safety-net advice. It is a dialogue that leads to a decision, not a form signed at the end.

Question 2

What counts as a material risk?

Accepted Answer

A risk is material if a reasonable person in the patient's position would be likely to attach significance to it, or if this particular patient would. It is not a fixed list attached to the procedure, so the clinician has to find out what matters to this patient. A short-lived flare may be trivial for most people and decisive for someone competing in 4 days.

Question 3

How should pressure from a coach or club be handled?

Accepted Answer

A decision must be made freely, and selection, contract and coaching pressure can distort it. See the athlete alone for the decision where possible, ask directly whether they feel under pressure, make clear the decision is theirs and that declining will not be described as non-compliance, and be explicit that your duty is to them as your patient.

Question 4

Does consent need to be taken again for a repeat injection?

Accepted Answer

Yes. Consent is reviewed rather than treated as permanent, so a decision made months earlier does not authorise a repeat procedure: the condition, the evidence and what matters to the patient may all have changed. The patient can also change their mind at any time, including during the procedure, and that is respected and recorded.

Consent and Decision-Making

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