The consent process is a critical part of the health professional’s consultation process with the patient.
It is imperative it is done well and documented accordingly.
In my experience, patients will not always admit they are struggling to understand or read the document due to embarrassment, so you need to have a procedure in place to manage this.
Below is a reasonably exhaustive step by step process to getting consent. I’m sure you may have additional comments so please let me know.
At the end of the day we all need to ensure our communication with our patients is crystal clear.
The 22 steps to getting consent.
- Use a board-approved (or association approved if your modality is not board regulated) template.
- If available use an age-specific form, e.g. modified to allow for the paediatric patient.
- Provide as much opportunity as possible for the patient to fully read and digest the information prior to the consultation, e.g. email or ask them to present to the clinic 15minutes prior to their appointment time.
- Allow for differences in comprehension and understanding, e.g. language and literacy barriers.
- Train your reception staff to assist where possible.
- Ensure the document is readable, e.g. appropriate font type and size.
- Make sure they sign the document after you have explained the form to them. This is very important.
- Encourage a spouse or partner to attend this part of the process.
- When going thru the form make sure you emphasize that you the practitioner must have their verbal consent every step of the way. They will give opportunities to say yes, no, stop or provide more information.
- Emphasize any obvious risks and write them on the form and then get the patient to initial, e.g. history of stroke, cervical spine fusion etc., anything that is a direct risk to treatment.
- Emphasise any and all risks associated with your treatment.
- Emphasize treatment options and alternatives and the benefits and risks associated.
- Emphasize relevant supporting evidence for your proposed treatment process.
- Discuss how many treatment sessions you anticipate and the approximate costs (consent is also about consenting to the number of sessions and the cost even though this may change)
- Physically demonstrate where possible, your treatment procedures, e.g. use an adjustment tool on their hand to demonstrate the forces, place a vacuum cup on their arm etc.
- Address any potential anxieties or pre-conceptions they may have right from the start.
- Break down the consultation process: ‘First we’re going to chat about your history and why you’re here, then we’ll move into the examination phase where I’ll suggest a working diagnosis. Then we’ll move into the treatment phase (Re-explain your treatment planning) and then I’ll provide you with a home plan and schedule for next visit. Is that ok?’
- Always involve the patient. It’s a team effort. Acknowledge their insights and observations. Empower the patient.
- Finally, have them sign the form explaining that is NOT A WAIVER but simply a communications agreement.
- Scan and upload this their file.
- If the patient sees other practitioners make sure they complete a consent for each modality.
- Add a note to your clinical notes as follows, ‘I have gone thru the consent form with the patient explaining risks, alternatives to treatment, evidence in support of my treatment plan and my proposed treatment plan and the patient has indicated to me their understanding of this process.’ This is an important last step that must accompany the written consent process.
If you still feel unsure get in touch with your regulatory board and/or professional association and get advice. Don’t skimp on this process.
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