1. IMPLIED CONSENT and INFORMED CONSENT It’s the law!!

2. 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 patient’s presence in the office, consent for the EXAMINATIONS is IMPLIED

3. IMPLIED CONSENT  Therefore, by the patient’s 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)

4. 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)

5. Questions about IMPLIED CONSENT?

6. 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

7. INFORMED CONSENT  The doctor must give the information he or she knows that may play a role in the patient’s decision about his or her health or health care choices

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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 patient’s condition or complaints change, or you must change your clinical impression, you must repeat INFORMED CONSENT

14. 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)?

15. 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

16. TWO RULES  Additionally, there are two rules associated with informed consent that you should be aware of:  The Doctor’s Rule  The Patient’s Rule

17. The Doctor’s Rule  In ALL states, the Doctor’s Rule applies: The doctor determines what information is important to deliver to the patient. Example: Kidney stone

18. The Patient’s Rule  In SOME states, the Patient’s 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