Informed Consent Guidelines
While a chiropractor may conform to applicable standards of care in the performance of assessments and treatment, that alone will not always prevent a legal claim for an unexpected result. Failure to inform the patient of the risk of such an outcome prior to the performance of a procedure can result in a claim for failing to obtain informed consent. As a general rule, informed consent is satisfied after the chiropractor has discussed with the patient all relevant information so as to assist the patient in making an informed decision as to whether or not to instruct the chiropractor to proceed with both examination and treatment. The rationale is simple. An informed decision as to care cannot be made without adequate information being provided on which to base that decision.
HISTORY
lnformed consent originally developed from common law principles of negligent nondisclosure. It has since evolved from repeated court decisions that the patient has a legal entitlement to participate in the decision making process regarding the type of treatment he or she is to undergo.
GENERAL GUIDELINES
It is generally accepted that to obtain the informed consent of the patient, the chiropractor needs to:
- Disclose the following information in understandable lay language:
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- What tests will be performed to work out a diagnosis
- What is the diagnosis of the existing problem
- Nature of the proposed treatment or procedure
- Inherent risks associated with the proposed procedure and possible consequences eg medical treatment including surgery
- Prognosis
- Feasible alternatives to the proposed treatment or procedure (including NO treatment)
- Inherent risks associated with the alternative treatments or procedures
2. Provide a generalised opportunity for the patient to question the chiropractor about any of the above.
DIAGNOSIS
It is required before treatment is rendered that there be a diagnosis of the existing condition and that this diagnosis be given in a manner that is readily understood by the patient.
LAY LANGUAGE
It is important to note that the discussion regarding the proposed procedure and alternatives must be presented in language and terms understandable by each individual patient.
CHIROPRACTOR MUST DISCUSS
The practitioner who is to perform the procedure must personally present the details of the case, and the patient must be able to question the provider regarding treatment or alternatives. A written consent form, while imperative for accurate record keeping, cannot be used as a substitute for the chiropractor’s discussion with the patient. As such the written consent form should be used as an aide memoir in the process of obtaining informed consent. The chiropractor must ensure that the content of the discussion/form, such as statistics quoted, are relevant to the patient and current. A thoughtful, well documented dialogue between the chiropractor and the patient can reduce misunderstandings and consequently the potential for a claim based on a purported failure to obtain informed consent.
SIGNATURES
Your consent form must be signed and dated by the patient and also by the chiropractor as evidence of the discussion all the elements of the consent form.
CONSENT IS LIMITED TO PROCEDURES DISCUSSED
It is important to note that consent is limited to the procedures discussed and is not open ended, Therefore, informed consent is an ongoing process and if symptoms alter or the nature of the treatment changes, or there is a substantial period between treatment, informed consent should again be obtained. Review is recommended every 6 months or so.
THE CONSENT FORM
The form should:
- Document the date and time of the consent process
- Include brief description of diagnosis, treatment and discussed risks/alternatives and a statement that the patient was given the opportunity to question the chiropractor regarding treatment or alternatives
- Provide space for signatures by the patient (and parent/guardian if under 18 years of age), chiropractor, and a witness if possible.
It should be clearly understood that the provided sample form should not be used on a uniform basis but is a guide only in finalising the chiropractor’s own document.
NO INFORMED CONSENT = NO TREATMENT
If informed consent is unable to be obtained, because the chiropractor is unable to take an adequate history or conduct an adequate assessment or the patient is in a position where they cannot or do not understand the informed consent discussion, we recommend that the chiropractor does not proceed but refers the patient to appropriate medical treatment.
