[Preoperative patient education. What is especially important?]

Any medical procedure must be legally authorized by the patient, giving informed consent. This prerequisite is based on the right to self determination. Otherwise a medical procedure is considered as physical injury. Thus, the way, how a specific procedure is performed, predominantly depends on the patient's will. The attending physician's duty is to find out this will, which is especially important when old patients and patients incapable of giving valid consent are involved. Before the procedure the physician has to have a confidential talk with the patient. He has to point out the best treatment possible considering the individual circumstances of the patient's life. The physician has to find out, weather the patient is competent to refuse or consent to treatment. Furthermore the consultation is an opportunity to diminish the patient's fear and to increase his confidence. The main problem treating old patients is that they often lack the mental ability for appreciation of the nature of the situation. One has to differentiate between the physiological mental decay and dementia or psychiatric diseases. In these cases a third party consent is necessary.