Informed Consent (part 2): what it is and what it isn’t

A previous post discussed the origins and development of informed consent. Hopefully that provides a good basis for understanding this post, which is a discussion about what informed consent is and isn’t. Many clinicians have come to know informed consent as a form, when it is in fact a discussion. Readers who haven’t seen the previous post on the origins of informed consent might want to read that post first (it can be found here), as it provides some of the background information for this post.

As was discussed in part 1, informed consent is a conversation between clinician and patient about the risks and benefits of a recommended treatment, as well as the pros and cons of alternative treatments. The majority of clinicians memorialize the conversation in a document that the patient signs. The question of how informed consent should be documented is occasionally the subject of heated debate between clinicians. Some feel that informed consent should be thoroughly documented in the chart as well as with standardized forms, after which all parties get copies. Other clinicians feel that patients who enter into a clinician’s office evince implied consent, and thus no formal documentation is required. In fact, both of these positions (and those in between) may be acceptable in a number of different circumstances, depending on the client and the facts and circumstances at hand. These discussions about how to document informed consent are important, particularly insofar as they raise awareness among clinicians about these issues. Clinicians should always consult with more experienced colleagues or legal counsel if they are unsure about what to do. However, these discussions about how to document sometimes eclipse the more substantive discussion about what to discuss with a client as part of an informed consent, as well as when to have the discussion(s).

Some thoughts to consider:

• Most patients, particularly those seeking clinical services for the first time, have many questions about what might happen. Talking with patients about what to expect is the most important part of informed consent. It’s not the signature on a form that is most important.

• Because clinical services usually aren’t discrete, informed consent can be an ongoing conversation about how things are going. Many clinicians already do this (via process comments, etc.) but don’t consider how this can be related to informed consent.

• Even without a form, a descriptive note in the patient’s file can do an excellent job. In fact, notes that speak to the specifics of the patient’s concerns and questions, as well as how they were addressed, can communicate much more useful information.

The take-home message here is for clinicians to not be so worried about getting forms signed that they mistake the symbol for its meaning. Forms are a more of a convenience than the goal and shouldn’t take the place of a meaningful discussion. Fortunately, there are few groups of people better prepared to engage in meaningful conversations than mental health clinicians.

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