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Creating a Discussion: More than Just a Checked Box

Jul 24, 2018

By: Elizabeth Leung, PT Student

Nervous. Anxious. Stressed. I am on my way into a mock practical. Okay, nameless examiner—I see you watching me in the background. I introduce myself to the fake patient. Great. I’m getting consent. That means I’m asking for consent. Check. She said “Yes.” Check. Okay, now that I’ve mumbled and motored my way through a few words, it’s time to answer the question on the door.

Did I really just “obtain consent”? Theoretically, yes. The examiner can’t say I didn’t ask for consent.

But is an uneducated, uninformed “Yes” truly a “Yes?” Not by a long shot.

Consent isn’t this little word that can be obtained simply by asking for it or ticking a box on a piece of paper. It’s a discussion. It’s a continuous open dialogue. It’s a time for questions and answers.

Read this. Sign that. Say “Yes.” Hurry up!

Okay, let’s start over again.

Why am I getting consent? But wait, consent isn’t about me.

Let’s change the question.

Why are you giving me consent? What does this mean to the patient? What are you saying “Yes” to?

Sometimes, learning to get consent as a student felt like it was all about me. And it kind of was, but what I practiced over and over in school about getting consent was suddenly difficult to translate into the real world. I felt a little unprepared to take that leap from student to clinician. 

Nervous. Anxious. Stressed. These were all of my feelings. But at that moment, it never occurred to me to consider that a patient could be feeling these things too, but for totally different reasons. That’s not something you can learn from a fake patient. And these feelings that your patient might have are not things you can assume are fine and under control just because they said “Yes.”

As a student in school, you’re doing things for you. You want good grades. You want the examiner to tick the boxes that prove that you did A, B, and C. It’s not until you’re face-to-face with a real patient that you finally start doing things for somebody else. And, I think that being a good physio starts with being good at obtaining consent.

Fast-forward a few months. I’m now on my way to an appointment, feeling those same familiar feelings—but this time as a patient. My surgeon takes her time discussing what it means to have open heart surgery. Suddenly, I feel my heart pounding and my body feels numb. I want to leave. I eyeball the door. I see her mouth moving but I don’t hear anything. (Um, I thought this only happened in movies?) She’s looking straight at me. I think I nodded my head? What did she say again? I’m embarrassed to ask. She slows down her speech, and draws me a diagram. She shows me images of my echocardiogram on the computer. I calm down. My heart stops pounding. She repeats herself and I can hear her voice again. She asks me if I have any questions. I did. She answers them all.

Thinking back on this experience, she was obtaining consent through an open dialogue. She was looking at my face, not at my medical records. She wasn’t bluntly asking me “Do you consent?” She wasn’t talking at me or merely sliding me a stack of papers to read and sign. She wanted me to really understand what was going to happen.

During my time here at the College, I’ve read through a number of cases that I would most definitely call a physio’s worst nightmare. It’s bad to get cautioned and it’s horrible to get disciplined. But, to have your license revoked permanently because you didn’t take the time to obtain valid, informed consent? It’s not just a nightmare for some—it’s a reality. And the worst part is, you’ve caused real harm to a patient. These cases are also permanently visible for anyone to read about on the Public Register

So, How Can I Avoid this Ever Happening to Me?

Combining my experiences here at the College, as a student working with real patients, and as a patient myself, I’ve crafted a short list to help me obtain valid, informed consent:

  1. Read the patient’s history. No, not just their past physical impairments and diagnosis. Pay close attention to any notes about their mental health history.
  2. Explain what you are going to do. Throw that physio jargon out the window and use simple language.
  3. Remind your patients they can stop the assessment/treatment at any time, that it’s okay to change their mind. Discuss the risks and benefits carefully. Let them ask questions. Even better, ask them to ask you questions.
  4. Slow down. Wait for them to digest all the information you just threw at them.
  5. Pay attention to their body language as well as their words. Base your clinical judgement on both.
  6. Write it down. You did not just go through this long journey of obtaining valid, informed consent just to accidentally forget to document it. It is important that you write down the consent process in the patient’s record. Yes, all of it.

Read the Consent Standard

 

Leave a comment
  1. Dave | Jul 30, 2018
    This is an excellent post!
  2. Stella Culbertson | Jul 26, 2018
    That was an excellent and extremely relevant blog post

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