Gary Shannon here.
Yes, the Chiropractor has to do this. In writing. Every patient.
Doctors are reluctant to give an adequate "
PARQ" (Procedure, Alternatives, Risks and Questions) before treating or examining the patient, even though there are few risks. For the patient it's often just another bit of paper to sign.
Since 1991, Oregon Board of Chiropractic Examiners Administrative Rule
811-035-0005 (2) says the patient has a right to information:
(2) The patient has the right to informed consent regarding examination, therapy and treatment procedures, risks and alternatives, and answers to questions with respect to the examination, therapy and treatment procedures, in terms that they can be reasonably expected to understand.
(a) Chiropractic physicians shall inform the patient of the diagnosis, plan of management, and prognosis in order to obtain a fully informed consent of the patient during the early course of treatment.
(b) In order to obtain the informed consent of a patient, the chiropractic physician shall explain the following:
(A) In general terms, the examination procedure or treatment to be undertaken;
(B) That there may be alternative examination procedures or methods of treatment, if any; and
(C) That there are risks, if any, to the examination procedure or treatment
In addition, your malpractice insurance carriers like doctors to use PARQ in writing and signed by the patient. Litigation attorneys who sue doctors hate them: if the suer signed off that the doctor TOLD them that there is a RISK of the problem they are having after care, and they AGREED to care anyway, they have no malpractice case. Without a PARQ in the file, it's only doctor's memory against patient memory.
ONE INFORMED CONSENT SOLUTION
Avoid all this by creating a template form to include with new patient and new exam papers. The OBCE gives an example of informed consent to new licensees as follows:
~~~~~~~~on your letterhead~~~~~~~~~~~
I hereby request and consent to the performance of chiropractic adjustments and other chiropractic procedures, including various modes of physical therapy, on me (or on the patient named below, for whom I am legally responsible) by the above named doctor of chiropractic.
Though chiropractic treatments are usually beneficial and rarely cause any problem, I understand that, like many other forms of health care, there are some risks. These can include, but are not limited to fractures, disc injuries, strokes, dislocation and sprains.
Alternatives to chiropractic treatment for common musculoskeletal conditions may include physical therapy, medications such as muscle relaxers and anti-inflammatory drugs and acupuncture.
I have has the opportunity to discuss with the doctor the purpose and benefits of the recommended chiropractic care, and alternatives to chiropractic treatment have been reviewed.
I further understand that health care providers cannot guarantee the results of treatment. I acknowledge that no guarantee of the outcome of chiropractic care I have requested has been made. I have had ample opportunity to ask questions, and my questions have been answered to my satisfaction.
Patient's name (printed)_______________________ Date____________________
Signature of patient ______________________________________________
or
Signature of parent/legal guardian _______________________________________
(if patient is a minor)
~~~~~~~~~~~~~~~~~~
Cautions on this form:
You need to add something to this if the patient asks specific questions, or has increased risk, say for osteoporosis or prior spinal surgery. Leave space for this.
If you know of additional risks, such as muscle soreness or dizziness, add them to the list above. There is a gray legal area here: Have all the risks above been verified by Chiropractic clinical trials? Is it acceptable to only list scientifically verified risks? What if the doctor disagrees with the validity of the trial? If the doctor personally and professionally recognizes an unverified risk, should he list it? Must he? These unanswered questions underline the difference between ethics and law. The simplest answer: list everything possible, and explain your opinions about them when asked.
Will patients ask questions because of this form? Usually.
Will patients skip care because of this form? Rarely.
As a patient and administrator, I prefer shorter forms that provide more information. I will provide one
in a later post.All the best to you and yours.
Gary Shannon
