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Removing the Fear of Discussing Informed Consent


We are going to be talking about a sticky topic that as practitioners I’m sure some of us try to shy away from, but it’s extremely important.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi everyone, and welcome to another episode of, to the point. I am Dr. Nell with the American Acupuncture Council, and I’d like to thank AAC for the opportunity to present today. We are going to be talking about a sticky topic that as practitioners I’m sure some of us try to shy away from, but it’s extremely important.

And that is removing the fear of discussing informed consent. As usual, I’m going to make sure that you all have tools at the end of this, that you can implement in your practice. Immediately. With that being said, let’s go to the.

Okay. So here’s how today’s going to get broken down. In, a short value-driven time period. We’re going to start with how you’re currently using informed consent. What does that look like? How patients actually feel about informed consent versus how we might feel about informed consent.

So some key element. Of informed consent, what needs to be in there for it to be effective. And then do’s, and don’ts because there are some things that we naturally want to do as practitioners that don’t necessarily align with what we need to be doing when having this important discussion. And then of course, those very tangible takeaways that we need for you all, to be able to say, Hey, I did this 15 minute live and now I’m going to implement in my practice.

So let’s dive right in. How are you currently using this? So when I say. We’re discussing informed consent. What does that first thought look like? Is it, oh, that’s that form? That’s in my electronic health records and it’s a quick sign off that patients do before they come in. Is that something that even gets discussed?

Is it part of your new patient packet when you’re coming in, your patients coming into the office and you have a stack of paperwork for them to fill out. They’re running late and you still want to get them in and they’re going through everything and just signing as quickly as possible. Do you actually use this as a counseling tool?

Do you go through it? Is it a written and verbal way to educate your patient on what their treatment plan is going to look like and what they should anticipate? Are some of you feeling unsure? I know I’ve been in this place before, when I was new to practice. Yes. I believe informed consent is a forum.

How am I utilizing that beyond a quick signature? And if we’re being honest, it might be this last one. Is it something you just get someone to sign as quickly as possible? Hoping that they won’t ask questions like, oh gosh, I don’t want them to ask about bruising or pneumothorax because that’s going to be an uncomfortable conversation.

We’re going to go through these and actually flip it. So you see what an incredible opportunity we do have. I truly believe that informed consent and discuss. Discussions around. It is probably one of the most underutilized patient retention tools. And usually we don’t think of it in that way. So that’s what I’m hoping you all are going to get out of this today.

So let’s keep going. So perception versus reality. So that last note that I had on. Slide about, are you just racing through it, hoping that they sign it in your electronic health records forms. And then we don’t have to really have a discussion around it because there are things like pneumothorax, bruising, potential bleeding burns from moxa or cupping.

Those are things that are actually in an informed consent. And so that can feel a little intimidating and a little scary to have to talk somebody through because our medicine is very safe. The good news is patients are very accustomed to signing informed consent. A lot of times it’s a very passive process.

Half the time they don’t even read it. But when we dive into those elements of informed consent, we’re going to see that. Not only them reading, but also understanding is a key part of that. And we want to make sure that we’re doing that. So with that being said, we are going to dial down our fear because patients are used to this.

If they go into any other medical practice, they’re accustomed to signing an informed consent form. And also. No those drug commercials or when you get a prescription and that long, long sheet of paper that lists all of the potential side effects of what they’re entering into with that prescription.

This is something that is so common nowadays, and it’s not unusual to go to a doctor’s office and have to sign an informed consent. And part of that is our legitimacy as medical providers, right? So we want to be doing things that align us with the healthcare delivery system. So we can provide that integrative care that is really patient centered.

That being. This looks intimidating, especially as a practitioner. We like to spend time with our patients. We have a very personalized medicine. We want to get to know them. And some of this can feel a little impersonal at first glance, but I want to briefly break this down for you because when you look at these elements of an informed consent form, You realize this is actually about patient centered care and this opens up true opportunities to dive into conversations that will actually help your patients come back into your practice.

So converting from new patients to overturning patient, so this whole form am definitely not reading it through. If you want a copy of this form. We do have one through the American acupuncture council and I am happy to send it to you. And my email is posted on this. So Nell at acupuncture,

I’d be more than happy to send you this because it’s a good, solid, informed consent form. But what does this actually say paragraph by paragraph? The first paragraph is just saying. As a patient, I understand that I’m signing this agreement and these are the things that are going to be included in this agreement.

Then we get into. That they are actually requesting the treatment. It’s not something that’s being forced upon them. It’s something that they are saying, yes. I would like acupuncture and I’m ready to enter into this treatment space. Different methods of treatment. So is it acupuncture? Is it ? Is it cupping?

Moxa. Those are the different methods that they could encounter herbal medicine when seeing a practitioner such as ourselves and then getting into the benefits and risks. Quite frankly, we should probably flip that. It’s a little more risks than benefits. Hopefully you are throughout the entire process of bringing a prospective patient into your practice and then retaining them as a patient you’re of course, going to be going over benefits in this form, though, there is more of a focus on the risks because patients need to be informed about what those potential risks may be.

And this is where I actually think that opportunity comes in for a discussion, which we’re going to go over in a few minutes. Something also very important results are not guaranteed and there’s no promise to cure. Now with this, that is standard across all medical practices, you are not going to go to a doctor’s office that tells you their results are guaranteed.

It’s not a spa experience. It’s not Walmart. It’s not, McDonald’s where you have it, your way. You’re a medical provider. And so we can’t make those promises. And especially in our medicine, we know. How individuals bodies respond very differently to treatment and those expectations have to be managed appropriately.

And again, that levels us up to being on par with other medical providers, because of course, we’re not going to promise to cure someone or guarantee results. And then going over the patient has responsibilities with this as well. It’s not just about you informing the patient. This is what they should anticipate, but it’s also the patient accepting responsibility for their part in this treatment.

What gets focused on in the informed consent when it comes to the patient’s responsibility is to inform the practitioner. So let’s say you have a patient who is not pregnant when they initially come into your practice. They should be letting you know if they become pregnant later on. If they stopped taking a medication.

If they start taking a medication, how would you know that unless you are in active communication with their MD or the patient tells you. And so we want to be really clear that there is a patient responsibility aspect to this informed consent. It’s not just about you as a practitioner, laying all these things out there for them.

And then alternatives to the care that you are recommending. And, in this particular form, might list and sides might list massage. What are things that people may be doing through the standard of care? Or could be doing other options that are out there for whatever ailment that they have, that they’re coming to you for treatment.

And it’s important because again, that’s informing the patient and that is true patient centered care. You want people to know what their options are and then an opportunity for questions. This is actually a requirement that. They’re signing off as the patient saying, I was given an opportunity to ask questions with this form.

And I think this is important because how do we remedy that with, the standard way that electronic health records and patient intakes are set up? A lot of times people are filling out this form before they come into your practice. And that’s not really the design of informed consent, and we are going to go a little bit into.

How this is so much more than a form and how you can incorporate this in every patient treatment that you give and that you need to be incorporating it in every patient treatment that.

Let’s look at the do’s and don’ts, so let’s not set it and forget it. So what do I mean by that? There are things that you do want to set it and forget it. Your business license, you want to make sure you take care of that. And that’s not really something that you might need to be thinking about on a day to day, your malpractice insurance, it protects you.

You’re paying for it every year. You know that you’re covered, you’re reading your policy. Should be reading your policy. But unless something arises, it’s not something that you have to actively engage with on a day-to-day basis. Informed consent is different. It is not something that you just have someone sign on that very first visit and then never have another conversation around it.

And I’ll tell you exactly how we implement that. We don’t want to limit that informed consent to the first visit. Okay. Every time you go into a patient room to check them when they have needles in, if you are taking needles out, if you are reinserting needles, that’s an informed consent conversation that communication that you have with your patient telling them that you’re going to be inserting a needle into GB 30, which is in a sensitive area.

That’s informed consent, asking the patient, if that’s okay, asking that they understand the purpose of that part of your treatment. So it’s something that you will engage in constantly. And we don’t want to shy away from discussing these key points of the informed consent, particularly those potential adverse events.

This is actually an opportunity to educate your patient because. If they are used to standard of care, if they’re used to integrative care, they’ve run into horrific potential side effects from treatment, whether it’s from pharmaceutical medication surgery, a lot of things that people with chronic illness.

Which is what we see in this country run into. And it’s actually an opportunity to get into those potential risks of treatment and educate the patient on how truly safe this medicine is. And you’ll be able to come up with your own ways. I can give you some examples in a minute of how to talk about bruising.

How to talk about how bruising from cupping is different than an injury bruise and. It’s the same thing. When people are doing sales, like to address the objections, you want to make sure you get in front of that because you don’t know where your patient’s mind is going to wander to. And how scary potential side effects could look for them.

And maybe they’re just mulling over that in their head. This gives you an opportunity to educate them on how unlikely some of the risks are and how common some of them are things to definitely do. And we, I just alluded to this a little bit, engage the patient in a collaborative conversation. When you’re making sure that they have time for their questions when you are welcoming those questions and actually going out of your way to elicit those questions by diving into them informed consent, that creates a bond with your patient that helps build trust.

That allows them to understand like, Hey. This person, this practitioner is truly engaged in helping me with my long-term health goals. This isn’t them just trying to get through paperwork, which unfortunately is something that patients are used to that will set you apart, engaging in that conversation and remain confident.

Because again, you are a medical provider, just like other medical providers that patients have seen in the past. You have this patient centered approach they’re already used to informed consent. So you taking the time to really dive into that with them, you should be confident. You are an expert in your field.

You’re more of an expert, even if you’re right out of school, more of an expert than the patient who’s coming to see you. So you deserve to have that. And realizing that patients are not, they’re just not intimidated by informed consent. They may have questions. I hope they have questions. I hope they’re engaged in their care.

That’s good for you as a provider. If someone is committed to their health and reaching their health. But just know that they’re not intimidated by this questions do not mean they’re against signing this form or engaging in this process now. All right. So like I told you, your tangible things, your action items for informed consent.

So I always tell students and practitioners, there is huge opportunity here. When you look at it as an opportunity to educate, and I am all about managing expectations. I think it is something that unfortunately, how many of you have had that patient who says, oh, I tried acupuncture before it doesn’t work.

Oh, how many times did you try it once? Did anyone tell them that it takes more than one treatment to receive sustained results for a chronic condition? No. So you get to be the provider who does educate that patient. So things that you can have a really engaged discussion on that actually turn your new patients into compliant followup patients who can become a life patients, because you’re building that trust and you’re managing the expectations on the front end.

Let’s talk about the results, not being guaranteed. Again, very standard across medical practices to have something in there saying results are not guaranteed. The way that I like to discuss this beyond just saying, in the form, we don’t guarantee results. Engage that patient in a discussion around how everyone’s body is.

How this medicine focuses on individualized, personalized, comprehensive care, which means that the patient that’s sitting in front of you, that’s suffering from insomnia and their friend who was suffering from insomnia and got this one point in time. Doesn’t mean it’s appropriate for the patient sitting in front of you.

That’s an opportunity to educate them on how treatment plans look different on how you are going to be putting your time, your energy, your commitment as a provider towards their personalized treatment plan. What a great way to discuss results, not being guaranteed. It’s about them. It’s about how their body responds.

That also engages the patient in this space where they realize, oh, I have. In my treatment plan as well. It’s not just about this doctor telling me what to do and I lay there on the table and get needles and it’s magically going to change my life. I have things that I can be doing outside of here. And that’s the same thing with no promise to cure.

It’s that personalized care we have to see how your body responds, knowing this medicine, this is what I anticipate. As you’re talking through your report of findings, you’re talking through your treatment plan. You get to utilize your expertise, but also make sure that the patient has some ownership in that.

This is an important one. There may be discomfort before relief. How many of you check in with your patient after that first? See how they’re doing, particularly if they’ve never had acupuncture before they’re coming in for pain, they feel great walking out the door. And then they go home to the stress of their kids or to the stress of work.

They are, physically moving things in a way where they don’t have proper biomechanics. They can do outside of your treatment. So many things to either promote your treatment and the good work that you did or completely tear it apart. And again, because of the individualized nature of our medicines, You don’t know which way that’s going to go for somebody.

And so knowing that there may be to some discomfort and that, we’re retraining the body, we’re reminding the body, what it feels like to be balanced, to have homeostasis that takes some time to stick. This is the managing expectations piece. And this all comes from a proper conversation around informed consent.

Okay. There’s no one size fits all approach. You are a wonderful, special individual. Who doesn’t want to feel special, making that patient feel special. And that you’re curating something just for them and knowing that they’re not going to be fixed after just one visit, you have to understand it’s not a no brainer for patients who haven’t experienced this medicine.

They are used to taking a pill and having symptoms go away. The problem isn’t necessarily solved, but that is the quick turnaround that immediate gratification that patients are accustomed to. And so we need to be able to recognize that, address it and explain that, it’s like a lot of things you could go to the gym.

You’re not going to get into shape or lose 10 pounds. It depends on what your goals are, how many treatments you’re going to need, how your body responds, but managing those expectations on the front end so that your patient doesn’t turn into somebody who goes to another acupuncturist, say it didn’t work for me.

And then I like to consider using more than one informed consent form. And I’ll tell you how I do this in my practice. And we have a. Host next week Michelle Gallas, who will be talking about cosmetic acupuncture. She is an expert in that field. And so she, might agree with this as well when you’re doing certain procedures like cosmetic acupuncture or micro-needling, there’s a higher risk involved with that.

It’s a little bit different than a general acupuncture treatment. Then cupping then Quasha. So I utilize AACS informed consent form, which has a very comprehensive, the form that we went over today. Very comprehensive list and you’re well covered. But I use an additional form for cosmetic acupuncture and microneedling.

The reason I do this is because it opens up yet another conversation. It doesn’t scare people off who are not getting cosmetic acupuncture and microneedling. If you have microneedle, you need to be listing bleeding. The face obviously is much more likely to bruise than other areas of the body.

You want people to stay out of the sun after microneedling depending on, what you use topically and. Depth all of that. So those are things you might not have to talk about with someone for a general acupuncture treatment. And so to keep the conversation really focused and make sure you are reaching the goal of having a patient who understands who is requesting the treatment excited about the treatment.

I like to use those separately. So if I have someone who comes in initially for a regular treatment, they’re being onboarded as a new patient, I will use the general informed consent because let’s say six months later, they’re like, wow, my GI issues are gone. My insomnia is better. I heard you do cosmetic work.

Can we do some of that? I want that new form coming in for a new discussion so that it’s fresh in their mind. And we have an opportunity to have that collaboration together, and the patient really understands what the expectations are. So I recommend always look for ways to discuss informed consent rather than shying away from it.

This is going to boost patient engagement, those referrals. You want patients who are excited and enthusiastic about the care that they received from you and something that makes us so different from other providers, patients usually see it’s not only that individualized approach, but that true connection that you have with your patients.

They want to feel that people want to feel heard. They want to feel validated, understood, and like you’re making a plan, especially for them. And so when we focus on that and look for ways that we can incorporate informed consent, whether it’s when you go in five minutes after the treatment is started, just to check on the patient, to stimulate the needle.

Let them know what you’re doing, ask them if it’s okay. Ask them how they’re feeling, how they’re responding. You get so much valuable feedback from that. And each touch point like that helps build trust with your patients who are then more likely to continue in your care and are more likely to refer other people to your practice.

So this is what we got through today. I hope that we’ve shifted some minds and hearts how we’re currently using the informed consent, how patients really feel about it. We went through those key elements do’s and don’ts, and then of course your tangible takeaways. So thank you all so much. For joining today I’m very excited about our next speaker next week on to the point, like I said, we have Michelle Gellis.

She is an expert in the cosmetic acupuncture field. I think, yeah, I might need to tune in and get some tips from her. So thank you all again for joining and be sure to share.