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  News from the Maryland Veterinary Medical Association                                                    Summer 2010

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?

  1. Have a discussion with your client(s) about their pet’s health, treatment, and prognoses.

  2. Offer written handouts about the pet’s health issue or prescribed medications/services.

  3. When possible, acquire written consent for treatment from the pet’s owner.

  4. 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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