Understanding Informed Consent: A Guide for Clinicians
HCPG has a question. How do you know you really gain informed consent?
Consent is both an important part of medical ethics but also human rights law.
Healthcare professionals and therapists are very aware that they need to gain consent from their patients and clients before they receive an examination or any treatment.
Where consent is part of our daily lives within clinic, perhaps the importance of understanding informed consent can begin to feel like a process as opposed to a compliance fundamental, which not only safeguards you and your client, but also your business and registration.
So, how do you currently go about gaining consent within your clinic?
- Ask them to sign a form when they first attend?
- Ask them at the beginning of the treatment session if they consent?
- Assume they have mental capacity?
If this feels familiar then let us look at what all this really means.
The Four Principals of Informed Consent
Perhaps we should start with defining what informed consent really entails. Going back to basics is essential when looking at sharpening any policies or procedures you have, and by not doing so can result in gaps in both knowledge and process.
There are ultimately four principals of informed consent which include:
- Describing the proposed intervention
- Emphasising the patient’s role in decision making
- Discussing alternatives to the proposed intervention
- Discussing the risks of the proposed intervention
The final element to gaining informed consent is assessing the client’s understanding of all of these points.
When we revisit the ways in which some clinics may be gaining informed consent as discussed earlier, it is evident that there are significant short falls in these three common practices.
Ask them to sign a form when they first attend
This may well be a standard process within your clinic, however, just by asking someone to complete a form is not gaining informed consent. Equally implied consent is certainly not gained just by your client turning up at your clinic.
At this very point, they only thing they can be consenting to is paying their invoice and for you to hold their data securely. The cold hard truth is that if you rely on this way of gaining informed consent, it is actually a meaningless process and would not stand up in any Court of Law.
Indeed, the Montgomery v Lanarkshire case in March 2015 drew a spotlight on the importance of informed consent. The case itself was a 16-year legal fight ending up in the Supreme Court and compensation of £5.25 million being awarded.
Ask them at the beginning of the treatment session if they consent
Perhaps you currently ask for consent at the beginning of a treatment. Have you really discussed all of the treatment and what this involves? Is your client expecting every single touch? Are they going to be taken by surprise by something they are not expecting?
The reality is that touching a person without consent may be classed as a civil offence of battery. This in itself can carry up to a six-month prison sentence, along with a fine up to the maximum of £5,000.
Assume they have mental capacity
We all know the saying ‘to assume’ makes an ‘ass’ out of ‘you’ and ‘me’, but when it comes to informed consent, to assume anything places you in very uncertain territory.
Informed consent has to meet three tests:
- The capacity to give consent
- Consent must be given voluntarily
- They patient must be given all the information they ask for in order to make that decision (Montgomery 2015)
It is essential to understand that in order for the client to have capacity to give consent they are able to:
- Understand the information
- Retain the information
- Use/assess the information to make an informed decision
- Communicate their decision by any means necessary
Getting it Right
In reality, gaining informed consent really starts with your client before they even arrive at your clinic.
How? Well, by sending out a Patient Information Leaflet either via post or email at the time of booking allows your client the time to digest information prior to their appointment. It can be a great way to introduce how you will work together, that there may be a need to undress, that they have a right to ask questions and that they can also refuse treatment.
Accessible and clear Patient Information Leaflets not only reinforce a professional clinic set-up but also provide clear evidence in documenting your commitment in managing client expectation and the foundations of consent.
They can also build trust with your client, for example covering points on chaperoning or interpreter services that are available.
In order to have gained full consent, you must be able to demonstrate that you have provided the client with any information that they have asked for. Providing clients with information prior to their appointment allows them time to digest, reflect and consider before going ahead with their treatment.
When working with clients whose treatment spans numerous appointments, planning ahead with information can be very helpful. For example, if your client’s treatment plan consists of Acupuncture, Injection Therapy, Dry Needling or Nerve Conduction Studies, written consent will need to be obtained.
It may be that information leaflets surrounding these treatments can help your client understand what is involved and also help reinforce your explanation of risks, benefits, side effects and associated complications.
Planning ahead can allow your client sufficient time to reflect and consider their options ahead of treatment and reduce the element of ‘surprise’, which no client should ever find themselves in. It also allows time within the next appointment to cover off any questions they may have and ensure continuity of their understanding.
How We Can Help
Having practiced within Physiotherapy for over 30 years we understand all too well the demands of a busy clinic. We also know, just how important compliance is to your business. Where compliance may not conjure up huge levels of excitement, it is without doubt the cornerstone to your practice.
We have worked with hundreds of clinicians in helping them develop robust polices, procedures and safe governance frameworks to drive their business forward.
From training sessions, auditing, bespoke workshops to support packages, we can help at every step of the way.
So, when it comes to Informed Consent there are some very simple things you can have in your practice which will help you along the way. These include:
- An Informed Consent Policy
- Written Consent Form (in line with NHS Consent Form 3)
- Patient Information Leaflet
If you would like further help or information around gaining informed consent or mental capacity we are on hand either online or in store, or why not sign up to one of our events and meet other professionals in a safe and interactive space.
We are here to help you ensure that your consent really is informed.
Want to keep learning? Find more articles from Sandra Harding and Sarah Tribe of HCPG: