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The Importance of Informed
Consent in Veterinary Medicine
by David Handel, DVM
There are many practitioners who
still remember when a handshake and a promise to do their best
was an adequate contract for services. Unfortunately, this is no
longer sufficient or appropriate. While we may miss the good old
days, the reality is that, as veterinarians, it is our
responsibility to inform our clients of available treatment
options, prognoses, and associated costs. In our litigious
society, this is best done both orally and in a written format.
A veterinarian’s best tool is their
ability to communicate. However, poor communication continues to
be a major area of concern. According to the Royal College of
Veterinary Surgeons, informed consent for procedures as well as
the failure to provide estimates prior to treatment cause the
most issues for clients. The RCVS states that it would be
beneficial to all parties if we, as veterinarians, put a greater
focus on these critical areas in an effort to decrease the
dissatisfaction so often expressed by the public.
In November 2007, the AVMA changed
the term “informed consent” to “owner consent.” The reason for
the change in language stems from the fact that the AVMA feels
that pet owners need to be supplied with information that allows
them to “make appropriate decisions when choosing the veterinary
care needed for their animals.”
So, what can we, as veterinarians, do to improve communication
and provide owners with the information they need to make good
decisions about their pets’ treatment?
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Have a discussion with your
client(s) about their pet’s health, treatment, and
prognoses.
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Offer written handouts about the
pet’s health issue or prescribed medications/services.
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When possible, acquire written
consent for treatment from the pet’s owner.
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Document all methods of client
communication in the medical record.
Having a discussion with your client
regarding their pet’s health is of the utmost importance. Our
clients need to feel that they can trust us as veterinary
professionals and know that we care about their pets’
well-being. Try to answer any questions they may have and
underscore the most salient points for them.
While oral communication is very effective, not all clients are
able to rapidly process everything we tell them. For this
reason, it is important that clients leave with information they
can revisit at a time that may be more appropriate for them. You
may either customize handouts or use any of the pre-printed
forms that are readily available on a variety of medical
conditions and pharmaceuticals. Pfizer’s FRANK program on
veterinary communication, about which you can read on the
company’s website, provides owner information sheets on a
variety of vaccines and medications for easy downloading and
sharing. Another valuable resource for you and your clients is
www.veterinarypartner.com.
Once a client understands what his
or her pet needs, the client can be actively involved in the
decision-making process. Obtaining consent for medical
procedures is helpful for both the client and the veterinarian.
By providing both a written estimate, as well as a description
of the service plan, both owner and veterinarian will start out
on the same page. Cost may be relevant to the client’s
decision-making and having all the information available will
help the client in making a decision. Clients should be
encouraged to ask questions and be given time to consider their
options. Offering an estimate with variable costs may also be
helpful, as this allows clients to understand what the costs
might be if a surgery becomes more complicated than originally
anticipated or if, for example, teeth need to be extracted
during a routine dental cleaning. It is important to have a way
to contact your clients should the treatment plan, and
associated costs, change. At a recent seminar, a lecturer even
suggested providing your clientele with pagers so they will be
available to you when you need them!
Finally, it is of paramount
importance that you document all discussions regarding care and
cost with your clients in the patient’s medical record. If you
provide a written estimate or medical plan, this should also
become part of the medical record. You may ask clients to sign
an estimate or a copy of a handout and keep a copy of this in
your records. Sometimes Mrs. A will drop off her pet for a
procedure and Mr. A will pick up the pet. When there is a
question about the services that were authorized, you will have
documentation of what was approved or provided. Medical records
can be your best friend if you use them wisely!
Many of us have seen cases that
underscore the importance of giving an estimate prior to
surgery. For example, a pet may be presented for an abdominal
exploratory. Mrs. A, the owner, is given a verbal estimate for
the surgery. During the procedure, however, the veterinarian
determines that the surgery is far more complicated than
originally anticipated, and the costs will escalate to more than
what Mrs. A was originally quoted. When Mrs. A arrives to
retrieve her pet and pay her bill, she vehemently complains that
she was not informed prior to her arrival of the increase in
cost. This has likely happened to all of us at one time or
another! The unfortunate situation is that, in most cases, the
veterinarian provided the appropriate level of care, but was
still left with an unhappy client. Providing our clients with
information and allowing them to be partners in the
decision-making process offer them both ownership and
accountability for their pet’s care. When a client understands
what is happening and why, as well as the costs associated with
the care, we are more likely to have a client who is pleased
with our services at the end of the day. |
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