Informed consent and patient communication
What informed consent requires
Informed consent is a process, not a signature. The chiropractor must explain the diagnosis or suspected condition, the nature and purpose of proposed treatment, material risks and expected benefits, reasonable alternatives including no treatment, and the consequences of refusing care. The patient must have capacity and an opportunity to ask questions. New Jersey law and Board rules require documentation of the discussion.
Special situations
- For minors, obtain consent from a parent or legal guardian and document the relationship.
- For high-velocity cervical manipulation, discuss the rare but serious risk of vertebral artery injury and document the discussion and the patient's decision.
- Informed refusal must be documented: what was offered, what was declined, what alternatives were given, and what the patient was told about the risk of refusal.
- Consent for one modality, such as spinal adjustment, does not authorize a different procedure such as electrical stimulation or X-rays.
Worked example
A patient signs a general consent form at the front desk, then later claims she was never told about the risk of cervical manipulation. Correct analysis: the generic form is weak evidence. The stronger defense is a progress note written the same day, in plain language, recording the specific risks discussed, the alternatives, and the patient's questions. Consent must be informed and documented for this patient, not merely signed.
Traps
- Relying on a signed form with no documented discussion.
- Obtaining consent by phone without a note.
- Failing to re-consent when the treatment plan materially changes.
- Treating a patient's silence or cooperation as consent.