Med consent forms?

[StayOnTop]

I've had colleagues in their practice do med consent forms where patients sign forms for every medication they start stating that they've understood the risks and benefits and what not. These seems cumbersome. Any benefit to this?

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[Sushirolls]

I do it. Send to it all patients through my portal.
But I don't get OCPD if they don't sign it.
Duality to hold me accountable to give a legit Risk/benefit/alternative discussion, and to also prompt patients to ask questions, too.

 

[ObsequiousAplomb]

I just document that we had an extensive conversation about the rba and that all questions were answered to apparent satisfaction. Idk if there really is much risk being assuaged by the signing of forms.

They either are referred to me by someone or they found me on their own by looking for a psychiatrist
They click multiple times on multiple pages to request a consultation
They sign multiple consents before they can schedule a first appointment.
They agree to see me, agree to take the medication, and agree to schedule a follow-up.
They go to a pharmacy that has a package insert with every fill, they have to sign that they have no questions or speak to a pharmacist when they pick the meds up.
They have to usually look at a bunch more warnings on the bottle from the pharmacy.
They pick the pill up and put it in their mouths, right?
That seems like ongoing enthusiastic consent.
Idk, maybe I'm wrong.

 

[Merovinge]

Malpractice defense security theater, largely from neurotic leaning psychiatrists. In CAP I make sure to always document the discussion I had for consent from parents/LGs, but with my rare young adult pts I briefly mention the specific med options I discussed, that we spoke about risks/benefits, and which one they chose. That's the standard of care. Having handouts for meds is a doubled edged sword, I can see the merit in that, if you choose to go with something like that I can see it having benefit to patient care.

Surgeons will eviscerate part of your body with a 1 liner or dot phrase about consent to surgery if that provides you context on the overkill some psychiatrists go through.

 

[annoyedpsychiatrist]

its in my note that medication risk/benefit/side effects were discussed, but i dont do official forms

 

[comp1]

I wonder if any of this has ever even been a speedbump for a medmal plaintiff's attorney's filings.

 

[calvnandhobbs68]

yeah I still do it but I've been more and more lax about it as time goes on. Usually the first med I start them on I'll have them do one of my consent forms for but after that I'm super inconsistent about it, unless it's a controlled med. The vast majority of the time I"ll have them sign a stimulant consent because it includes stuff about not diverting the substance, requirements for f/u frequency, etc.

I guess I figure after the first med I have a decent enough rapport with people that they're still sticking with me for the second, third, forth, etc so probability of any lawsuit even with a bad outcome goes down. Who knows if that's true.

Surgeons will eviscerate part of your body with a 1 liner or dot phrase about consent to surgery if that provides you context on the overkill some psychiatrists go through.

Maybe that's in their clinic note but I've never had a surgery or procedure without having to sign multiple different forms about financial, surgical, anesthesia consent, etc. especially if it's a planned procedure. I agree that plenty of people start all kinds of meds though that are a lot riskier without any kind of special "med consent" forms.

 

[Ironspy]

yeah I still do it but I've been more and more lax about it as time goes on. Usually the first med I start them on I'll have them do one of my consent forms for but after that I'm super inconsistent about it, unless it's a controlled med. The vast majority of the time I"ll have them sign a stimulant consent because it includes stuff about not diverting the substance, requirements for f/u frequency, etc.

I guess I figure after the first med I have a decent enough rapport with people that they're still sticking with me for the second, third, forth, etc so probability of any lawsuit even with a bad outcome goes down. Who knows if that's true.



Maybe that's in their clinic note but I've never had a surgery or procedure without having to sign multiple different forms about financial, surgical, anesthesia consent, etc. especially if it's a planned procedure. I agree that plenty of people start all kinds of meds though that are a lot riskier without any kind of special "med consent" forms.

For my scheduled c section there was one mad libs-style sheet with one line for complications and only 3-4 of the most common complications were listed with no additional information or explanation. One sheet per psych med seems like overkill

 

[whopper]

I just do a smartphrase showing I explained to the patient the risks, benefits, and it's up to them if they want to do the treatment.

 

[Sushirolls]

Part of my thoughts were our top 3 liability reasons:
1) med side effects
2) SA completion
3) Sex

#3, I feel very confident in not having that be a liability concern.
#2, we practically have little to no control over
#1, perhaps an extra sheet mitigates a little bit? at worse time waste. Middle of road my 'air plane pilot' checklist to keep me on track and doing it.

 

[comp1]

Some states do require a sign to be posted that "Therapy never involves sex." I'm guessing that's just about as useful in medmal as an addendum saying you discussed and benefits generally.

 

[hamstergang]

I did this when required in some settings but haven't as soon as I was able. I find it so stupid as the patient's actions clearly indicate their consent, and we can document the discussion just like we document everything else we claim happened in the session. Also, no other field of medicine does this that I'm aware of. Feels discriminatory, as though our meds are somehow thought of as more dangerous than everyone else's.

 

[Merovinge]

I did this when required in some settings but haven't as soon as I was able. I find it so stupid as the patient's actions clearly indicate their consent, and we can document the discussion just like we document everything else we claim happened in the session. Also, no other field of medicine does this that I'm aware of. Feels discriminatory, as though our meds are somehow thought of as more dangerous than everyone else's.

Right, people use far more SE burdensome medications in IM and IM specialties without any of these hoops psychiatrists go through. For any historians, I am curious if this relates to more patient's we treat being presumed to not have capacity and thus us documenting that more of if it was in fact corporate CYA or neurotic psychiatrist CYA.

 

[ObsequiousAplomb]

Right, people use far more SE burdensome medications in IM and IM specialties without any of these hoops psychiatrists go through. For any historians, I am curious if this relates to more patient's we treat being presumed to not have capacity and thus us documenting that more of if it was in fact corporate CYA or neurotic psychiatrist CYA.

I mean, I don't document informed consent for floridly psychotic patients who don't have that capacity. It's kinda obvious though, isn't it?

 

[esob]

We do these for inpatient, and the attendings (most), have the residents sign them. I feel reasonably sure that no pt has ever been accurately informed about their medicine but it seems like part of the machine to force the pt to sign it, force the nurse to sign it, then force the resident to sign it (even if you've never seen that pt). I sometimes sign my name so sloppy that it looks like Sanskrit as my only plausible means of rebellion against the machine

 

[aim-agm]

I mean, I don't document informed consent for floridly psychotic patients who don't have that capacity. It's kinda obvious though, isn't it?

My state had regulation that, for involuntarily admitted patients, you can entirely omit information (e.g. about side effects) if you think that info would lead the patient to refuse medication.

Technically, the regulations would even allow you to sneak up on a patient and inject them with medication (or put it in their food) without their knowledge or consent (even outside of emergencies)...you'd still probably get in legal trouble because that would be substantially below the standard of care, but unlike in most other contexts it probably wouldn't be a felony.

 

[comp1]

Wow, I like those state regs...but it does explain why the VA has required facilities in certain states (and not others) to exceed their state requirements for involuntary medications...

 

[aim-agm]

Wow, I like those state regs...but it does explain why the VA has required facilities in certain states (and not others) to exceed their state requirements for involuntary medications...

I suspect this is in part related to VA decisions/values regarding how veteran's rights are respected possibly be more stringent than those states, but also because of legal issues it runs into.

The VA is weird since being federal means they can ignore state law if they want, but they typically need to rely on it for areas where there isn't federal law, e.g. there isn't a broadly applicable federal commitment law so they need to rely on state law.

It can get even more complicated since at least some states allow for a veteran to be sent or accepted across state lines to a VA facility (although it is a process) but retain jurisdiction over the patient, which creates even more complications. So different state laws and regulations can apply to different patients in the same hospital, or possibly even different facets (e.g. commitment and medication over objection) of the same patient.

Again, the VA is weird.

 

[ObsequiousAplomb]

My state had regulation that, for involuntarily admitted patients, you can entirely omit information (e.g. about side effects) if you think that info would lead the patient to refuse medication.

Technically, the regulations would even allow you to sneak up on a patient and inject them with medication (or put it in their food) without their knowledge or consent (even outside of emergencies)...you'd still probably get in legal trouble because that would be substantially below the standard of care, but unlike in most other contexts it probably wouldn't be a felony.

In state hospital populations, for very select individuals, putting clozapine / lithium in their food is the most humane way for them to live, though that is just my opinion.

 

[FlowRate]

I've only once ever had a patient physically sign a consent form and it's because the rheumatologist felt it was legitimately a super high risk decision to restart the specific class of medication but the patient felt his life was dramatically disrupted for the worse without it. (And alternatives were not nearly as effective.)

He's back on it and doing fine and no recurrence of the issue that the medication potentially caused or contributed to, thankfully.

 

[ObsequiousAplomb]

I've only once ever had a patient physically sign a consent form and it's because the rheumatologist felt it was legitimately a super high risk decision to restart the specific class of medication but the patient felt his life was dramatically disrupted for the worse without it. (And alternatives were not nearly as effective.)

He's back on it and doing fine and no recurrence of the issue that the medication potentially caused or contributed to, thankfully.

what was the medication? The only psychotropic that comes to mind a rheumatologist might be upset about is Thorazine for drug-induced lupus. Am I way off?

 

[FlowRate]

what was the medication? The only psychotropic that comes to mind a rheumatologist might be upset about is Thorazine for drug-induced lupus. Am I way off?

I think the specifics are rare/unusual enough that it might be too identifying. The very short version is severe vasospasm causing necrosis and stimulant medication.