Nell Smircina, MBA, DAOM, LAc, Dipl. OM
How are you currently using informed consent in your practice? As a quick sign-off on your EHR before the patient comes in? As part of your new-patient packet in your office? Maybe it's something you know you "have to" have people sign, but you're secretly hoping they will sign it and not ask any questions about bruising or pneumothorax. Am I close?
There's a perception-vs.-reality gap we need to address: How you may feel about informed consent is very different from how patients feel about it. Patients are accustomed to signing an informed-consent form when they enter into a medical practice. Having this form simply helps add to our positioning as medical professionals.
But that's not all: It also is a highly underutilized patient retention opportunity. More educated patients who truly understand what you are doing and why you are doing it are much more likely to engage in a recommended treatment plan.
8 Key Elements of an Informed-Consent Form
What are the key elements in an informed-consent form, and how does this become a tool that's even more powerful than just something to legally protect you?
1. An initial statement that explains what an informed-consent form is, and to which the patient agrees they understand: This is simple and straightforward. You want your patient to know what they are signing.
2. A request for treatment: Yes, a request. Your patient is saying they are requesting the services you provide, rather than simply passively agreeing to be treated.
3. Methods of treatment: This section reviews different modalities that may be used, like acupuncture, moxa, cupping, herbs, etc. This is a huge opportunity to discuss with your patient the potential tools you may use to help them; and assist them in understanding the safety of these tools.
4. Benefits and risks: Usually there is more space used on the page for risks, but even in discussing risks you have a tremendous opportunity to educate. Patients are so accustomed to hearing about myriad potential side effects (Ever seen a pharmaceutical ad?), so even though we may cringe talking about potential bruising, this is actually an opportunity to demonstrate to a patient how truly safe this medicine is. Our potential risks are far less risky than your average medical procedure.
5. Results are not guaranteed (no promise to cure): If you know me, you know how obsessed I am with managing expectations. This is your time to manage a patient's expectations about their treatment plan and prognosis. This is your time to make sure your patient does not become one of those "I tried acupuncture and it didn't work" people because their practitioner never impressed upon them the cumulative nature of treatment. We utilize a highly customizable medicine and it's important the patient understands that everyone responds differently.
6. Patient responsibilities: Yes, the patient has responsibilities here! It's not just on you as the practitioner. If they change medications, herbs, get pregnant, etc., they need to let you know. And you need to make sure they understand the gravity of this section. This also takes the pressure off you a bit – although you are the expert for their treatment, they also have a responsibility to support that treatment with what they do outside of the office.
7. Alternatives to treatment: This usually is a list of standards of care or other integrative modalities that may be applicable for their condition. If you work closely with other providers, it's also an exceptional time to discuss referrals or expanding the care team. Patients love this and feel supported by your network.
8. Opportunity for questions: Don't ever miss an opportunity to solicit questions from your patient. If you've done this well, they should have felt comfortable asking questions all along. But holding space for patients to ask is critical.
Practice Pearls / Next Time
Many practitioners shy away from critical conversations around informed consent, but the more comfortable you are with this document, and addressing any questions, the more likely your patient will be comfortable with and committed to working with you.
Next time, we'll get into ways to incorporate informed consent beyond the physical form, as well as the do's and don'ts of informed consent – giving you all the tools to master this essential skill in your practice.
