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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 consent form when they book an appointment for the first time. In his email to new patients, he asks that they bring the signed intake and consent form to their first appointment with him so that he can get on with the business of making his patients feel better. Mike also states that he will provide respectful and effective care according to each patient’s needs.

A new patient named Therese arrives for her appointment one morning, 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 Mike lots of questions about his approach to care because other massage therapy treatments have left her in significant pain. Mike finds Therese’s questions distracting and annoying. He says to her, “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 consent as an administrative duty rather than part of his legal and ethical commitment to patients. Despite Mike’s indication in his email to new patients that he intends to provide respectful and effective care, his actions prove the opposite.

By combining the consent form with the intake form, Mike eliminates 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. Plus, he excludes patients from asking about his clinical framework for care prior to signing consent, contrary to a principle of patient-centred care regarding shared decision-making. 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 must not ask that new patients sign a consent form before arriving at their initial appointment. A patient may fill out an intake form in advance with questions about health history to save time at the first session, but the same is not true for informed consent. The consent standard requires that the patient is provided with information specific to the RMT’s clinical framework, and has an opportunity to ask questions about massage therapy.

Instead of providing a comprehensive explanation of his approach to treatment, Mike suggests that if Therese doesn’t like the way he works, she should find another therapist. This is in violation of the Code of Ethics and the Consent Standard of Practice. At no time does Mike ask Therese about her goals, nor does he inform her of potential concerns or consequences of treatment. He doesn’t offer options for positioning or draping, nor does he advise Therese that she can stop or change the treatment direction 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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