Instilling confidence and giving fair warning

As a trained health professional, you have a right to display confidence in your ability to treat patients and to expect to see the positive results of your skilled intervention. However, you also would know that there are no guarantees in life, and that there is bound to be some degree of variability in treatment outcomes from patient to patient. Finding the right balance between showing confidence in your treatment plans and giving fair warning of any risk associated with your treatment is key to obtaining informed consent from your patients.

Communication is a two-way street

When obtaining informed consent there are two types of risk that need to be canvassed with your patient, those risks that are common but slight and those that are rare but serious.

Practice working into your conversation the risks that a treatment may involve without creating unnecessary fear. For example, “There are many documented benefits to the treatment I’m proposing , but as with anything there are some risks that, although unlikely, I would like you to be aware of”.

Written consent from the patient can be useful but it should be noted that obtaining informed consent should be a more involved process than simply obtaining a signature on a form. The onus is on you as a practitioner to ask the right questions and to respond in lay language so that you are understood by the patient.

In the process of obtaining informed consent you would want the patient to understand:

• The nature and likely prognosis of their condition.
• The options available for additional diagnosis and confirmation of the condition.
• The care options available, the approaches and their benefits.
• Warnings with regard to the degree of uncertainty of an outcome.
• Warnings regarding possible adverse outcomes (as noted above).
• Time and cost involved in their care, and any aspect of their care that may be especially costly or protracted.

In many circumstances, dissatisfaction arises from the level of costs and the level of patient consultation rather than the treatment outcome . It is desirable that patients are informed of costs prior to treatment, preferably in writing.

As treatment plans change, obtain and document consent once again. For practitioners in the public sector or in a hospital context, obtain and document consent even where the treatment you provide is one part of a larger treatment program.

Disclose material risks

Material risk means “risk for the individual”. The materiality of risk differs greatly between patients. For example, a pianist will place a higher importance on any risk to their hands and fingers, and a sportsman, who’s physical wellbeing is their livelihood, can be expected to have a closer interest in the outcome than an office worker.

The exact risks and benefits and the detail of explanation required will differ with each patient and each procedure. Risks that might if known cause the patient to decline the treatment you recommend, must always be explained and recorded along with the patient’s response.

Keep it on the record

You need to remember that in a legal setting what you say you said, means very little. What you documented that you said, means a lot. It is no secret that sound communication and full documentation are the keys to achieving informed consent.

Visit Riskequip for Physiotherapy and take the Self Check Q&A for Consent to self-assess your management of risks relating to consent.