IMPLIED CONSENT and INFORMED CONSENT

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IMPLIED CONSENT andINFORMED CONSENT

• Its the law!!

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What is Implied Consent?

• During the first visit (or first visit of a new
  complaint or condition), the doctor must gather
  information about that patient
• The doctor must take a case history and must
  perform necessary examinations
• By the patients presence in the office, consent
  for the EXAMINATIONS is IMPLIED

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IMPLIED CONSENT

• Therefore, by the patients presence in your
  office, you do not need to obtain written
  permission to perform necessary examinations
• Verbal consent to perform exam is all that is
  needed for most situations (in DC offices)

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IMPLIED CONSENT

• He or she is automatically giving you permission
  for information-gathering only
• The patient has NOT given the doctor permission
  to perform any interventions/treatments/therapies
  (i.e. an adjustment)
• Obviously, exceptions apply when the situation is
  critical (ER, EMT)

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Questions about IMPLIED CONSENT?
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INFORMED CONSENT

• It is both a process and paperwork
• Informed consent begins after the doctor has
  gathered all necessary information and has
  determined the necessary intervention

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INFORMED CONSENT

• The doctor must give the information he or she
  knows that may play a role in the patients
  decision about his or her health or health care
  choices

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INFORMED CONSENT

• There are 5 important elements of the informed
  consent process
• 1. Diagnosis/Clinical Impression
• Patient wants to know
• What is wrong with me?
• This must be given in understandable terms

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INFORMED CONSENT

• 2. Treatment/Intervention
• The patient wants to know
• Can you help me?
• This is NOT the time to explain the exact
  technique of adjusting or biomechanics of
  adjusting. One explains how chiropractic can
  help with the particular diagnosis from element
  1

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INFORMED CONSENT

• 3. Risks or complications associated with the
  treatment or with the diagnosis
• In some states, you are required to explain in
  writing
• For example, you must give lifting restrictions
  to a patient with an acute disc herniation

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INFORMED CONSENT

• 4. Alternative treatments, concurrent treatments,
  or additional diagnostic procedures
• This is the time to tell the patient if more
  treatments or tests are needed (either within or
  outside of your office)

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INFORMED CONSENT

• 5. Successes and Failures
• The patient wants to know
• What is my prognosis?
• This information is based upon personal
  experiences of the doctor, literature, research,
  classroom knowledge

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INFORMED CONSENT

• So, by informing the patient of the 5 elements,
  you have completed the process of INFORMED
  CONSENT
• By having the patient sign the form, you have
  completed the paperwork part of INFORMED CONSENT
• Remember, though, that if the patients condition
  or complaints change, or you must change your
  clinical impression, you must repeat INFORMED
  CONSENT

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IS THIS FOR PALMER ONLY?

• You must utilize an informed consent process for
  every patient in your office
• What if you do not inform a patient prior to an
  adjustment (or any form of treatment)?

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What about minors?

• In Iowa and Illinois, care of any patient under
  the age of 18 requires the consent of a parent or
  a legal guardian
• The parent or legal guardian is required to be
  present on the first visit

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TWO RULES

• Additionally, there are two rules associated with
  informed consent that you should be aware of
• The Doctors Rule
• The Patients Rule

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The Doctors Rule

• In ALL states, the Doctors Rule applies
• The doctor determines what information is
  important to deliver to the patient.
• Example Kidney stone

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The Patients Rule

• In SOME states, the Patients Rule applies
• The doctor must give any and all information to
  the patient in order for him or her to make an
  informed decision about his or her health care
  options
• Example Kidney stone
• It is not a rule that the patient must tell the
  doctor everything about the complaint