Few patients have more than the barest understanding of how their bodies work, Their assumptions for treatment are based on a desire for health and on a conditioned respect for a doctor's care. A consultant's intentions are affected by such diverse constraints as funding, priorities in patient care, training needs, or a personal desire to try out a new technique. Such an ill-matched pairing can turn "informed consent" into "misguided compliance". For example, a person may agree to an operation believing his consultant will look after him, and never know that not he, but a subordinate, operated.
In 1993, it was reported that thousands of anaesthetized women awaiting operations in teaching hospitals in the UK had been unknowingly used as subjects for gynaecological students. Of the 17 of 29 UK medical schools which responded to a survey in 1991, 6 required written consent for a vaginal examination, 8 told medical students to get the patient's verbal consent (but had no inbuilt monitoring procedures that this was done), and 3 had no formal system of obtaining informed consent.
Asking for a patient's consent before an operation is a charade. People are not always given full information about their illness or about possible alternative treatments, and surgeons pay to little attention to the sensitivities of patients. As a group they place restriction and constraints on good practices like randomized control trials in which to test surgical procedures, and yet allow unrestrained innovative surgery.