Informed Consent: The Ceremony

By William Morgan, DC

There is healing power in trusting relationships. Informed consent can be a tool to elevate doctor-patient trust and thus enhance healing.

If orchestrated properly, the seemingly onerous administrative task of presenting a patient with an informed consent form can be elevated to a ceremony of physician-patient alliance, trust and partnership. Much like a wedding ceremony, where a relationship is elevated and memorialized, the consent “ceremony” can be a testament to your commitment to be honest and forthright with your patients.

I have been consenting patients for the past 10 years (of my 25 years in continuous practice) and have only had two patients refuse treatment after I read the consent to them. However, I have had thousands of patients who have trusted me all the more for honestly portraying the risks of treatment.

The Ceremony
After completing the patient interview and physical examination, sit down facing the patient and look him or her in the eyes. Lean forward, and explain the need for the informed consent. Assume a serious expression and air. Then take a moment to read the consent to the patient. If the consent is particularly long, read the portion that explains the risks. Then look the patient in the eyes again and explain, “These are real risks, or we would not put them in our consent. They are rare but not unheard of. Certainly these are not rare if they happen to you. I just wanted to look you in the eyes to explain the risk versus the benefi t of this treatment. There must be a perceived benefi t to justify the risk. I am not a salesman: Is this a path you would like to take? Do you have any questions? Would you like to proceed?”

At this point, honestly answer any questions and avoid saying something like “These things never happen” or “This is just a formality” or ”Just sign here.” Do not use humor or silly comments. Use this moment to begin a superb doctorpatient relationship.

I like to remind patients that the informed consent is an ongoing process; it is not just a document. I go on to say, “If at any time you feel uncomfortable with me, the treatment or anything in this offi ce, you have the right to reconsider.”

After they have consented to care and have signed the form, I sign the form and pledge that I will do everything in my power to heal them and not harm them.

When physicians and patients form alliances based on reciprocal respect and trust, there is an elevation of communication and healing. The primary reason we gain patient consent is to respect the patient’s own values. It is about autonomy and the right of people to be informed so they can make their own decisions.

I would challenge my fellow doctors of chiropractic to look on the informed consent not as another administrative hoop to jump through but rather as a chance to win your patients’ trust and respect. Try to make this event a milestone in your relationship with each and every patient.

Dr. Morgan shares his clinical time among a hospital-based chiropractic clinic and two Washington, D.C., executive health clinics. He is adjunct faculty for F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences and New York College of Chiropractic. He can be reached through his Web site, www.drmorgan.info.