Not without my consent
Sound communication and full documentation are the keys to achieving informed consent in a professional health practice.
As a chiropractor, it is essential for you to document the consent process that has taken place during your consultation with a patient. A consent form is available on the CAA website, and is recommended for use by CAA members to assist with the consent process. It should be noted however that obtaining informed consent is a more involved process than simply obtaining a signature on a form. A signature on a consent form alone will not necessarily prove that consent was given.
Times have changed
In the past many health professionals may have relied on implied consent and assumed that the presentation of a patient seeking their professional care provided them with the mandate to proceed as considered necessary. In today’s litigious environment, adopting such an approach would be considered a precarious practice. Instead, appropriate evidence of informed consent would include a signed and dated file note (in the handwriting of the chiropractor) documenting a complete record of the interaction, revealing that the patient consented to the care explained to them.
The right questions
Mind reading is not a skill expected of a chiropractor. Chiropractors are expected, however, to ask relevant questions so that they can ascertain a patient’s level of understanding and expectations, and tailor their care accordingly. A patient will then understand what care they will receive. Again, it is important keep an accurate record of this exchange of information.
Risk perceptions
The perception of risk and the materiality of risk can vary greatly between individuals. It is with this in mind that the precise risks and benefits of the intended care and the detail in which they warrant explanation, will differ from patient to patient. The material risks are those that might, if known, cause the patient to decline a procedure. Always explain these risks to your patient and record the communication process.
When obtaining informed consent there are two types of risk that need to be canvassed with the patient, those risks that are common but slight and those that are rare but serious. Both need to be approached taking into consideration the knowledge, vocation and circumstances of your patient. For example, a professional dancer could be expected to have a closer interest in their chiropractic care outcome than an accountant.
In summary, when a chiropractor obtains informed consent from a patient, it would be prudent to advise of:
- The nature and likely prognosis of the patient’s condition
- The options available for additional diagnosis and confirmation of the condition
- The care options available, their benefits and their approach
- Warnings with regard to the degree of uncertainty of an outcome
- Warnings regarding possible adverse outcomes (the two types of risk as noted above)
- Time and cost involved in their care, and any aspect of their care that may be especially costly or protracted.
Once may not be enough
Obtaining consent is not just a once-only exercise. If the course of a patient’s care varies for any reason then it would be sensible to obtain and document a new act of consent in the patient’s record. If there has been no change in the course of treatment, informed consent should be obtained every six months at least or for every ‘new’ period of treatment, ie. If someone ceases treatment for a period of time but then returns, even if treatment is the same as that previously administered.
Remember that your records (particularly in an adversarial context) are your greatest defence. Evidence of consent can protect you, and it can also protect the patient.
Guild Insurance Limited AFSL No. 233791.
