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Obtaining and documenting consent from a new patient

Case study: Obtaining and documenting consent from a new patient

Mike runs a busy downtown multi-disciplinary clinic. In addition to all the clinic administration, staffing, and marketing, he treats more than 30 patients per week. Mike always looks for ways to manage his time more efficiently. He decides to shorten the intake process for new patients by emailing a combined intake and informed consent form when they book an appointment for the first time. In his email to new patients, he asks that they bring this form signed to their first appointment with him so that he can get on with the business of making his patients better. Mike also states that he will provide respectful and effective care according to each patient’s needs.

One morning a new patient named Therese arrives for her appointment, having neglected to complete Mike’s intake and consent form. Therese suffers from chronic pain as a result of a motor vehicle accident. She asks lots of questions about Mike’s approach to care because other massage therapy treatments have left her in significant pain. Mike finds Therese’s questions distracting and somewhat annoying. He says to her, as gently as he can, “I have been in practice for many years and I haven’t had a complaint from anyone. This is the way I work. My patients report good outcomes to my treatment. If my approach doesn’t suit you, perhaps you would be better off with a different therapist.”

Do Mike’s actions meet the consent standard of practice?

No. Mike ignores the principle and purpose of informed consent. He perceives the requirement for expressed and written consent as an administrative duty rather than part of his legal and ethical commitment to patients. Despite Mike indicating in his email to new patients that he intends to provide respectful and effective care, his actions prove the opposite.

By combining the informed consent form with the intake form, Mike cuts short the opportunity for discussion with a new patient, and demonstrates that his interest in patient information is limited to what can be included on his form. When Therese asks questions about Mike’s approach to care, he becomes annoyed rather than listening to Therese’s concerns, answering questions, or informing her about options. RMTs should not request that new patients sign a consent form before arriving at the initial appointment. While a patient may fill out an intake form with questions about health history in advance to save time at the first session, informed consent requires that the patient be provided information specific to the patient’s presenting condition and goals in seeking massage therapy, and is provided with an opportunity to ask questions.

Instead of providing a comprehensive explanation of his proposed assessment or treatment, Mike suggests that if Therese doesn’t like the way he works, she should find another therapist. At no time does Mike ask Therese about her goals, nor does he inform her about potential concerns or consequences of treatment. He doesn’t offer options for positioning or draping, nor does he provide Therese with the option of stopping or changing the treatment at any time. Finally, although Mike retains the signed intake and consent forms in patient files, he asks patients to sign their forms before they even meet him and have the opportunity to receive information and ask questions. These actions do not support informed consent in any way.

Consent standard of practice case studies

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