The Situation

Brian hurt his back playing hockey and made an appointment to see Joe Smith, PT at ABC Physiotherapy Clinic. Upon arrival he was greeted by ABC Clinic’s friendly receptionist Mariana. Mariana asked Brian to take a few minutes to fill out some forms and provide his signature to indicate his consent for assessment and treatment. Brian signed the forms without really reading them and began telling Mariana about the great shot he was taking when his back ‘went out’.

When Joe Smith, PT was selected for a random practice assessment, one of the issues identified by the assessor was that although there was a signed consent form in Brian’s chart, there had been no discussion with Brian about the risks, benefits, alternatives or consequences of the assessment and treatment. 

The Requirement

Consent must be obtained for assessment and treatment. Informed consent includes having the opportunity to ask questions and receive answers from the person proposing the treatment. How can Brian consent to assessment and treatment without even knowing what it will involve? Signing forms provided by the receptionist is not a substitute for meaningful discussion between patient and physiotherapist. The presence of signed forms does not, in itself, satisfy the expectation that such a discussion took place. Consent need not be provided in writing but PTs must document the fact that the discussion related to consent did occur. 

The Consequences

The Quality Management Committee needs to be assured that documentation reflects the patient’s valid consent to, or refusal of, the proposed assessment or treatment. It should contain enough detail about the discussion of risks and benefits to promote confidence that the patient’s decisions are informed. The Committee required that Joe undergo a period of practice enhancement during which he was required to review the College’s Briefing Note on the Health Care Consent Act, the e-learning module on obtaining informed consent as well as the record keeping resources. All are available on the College website www.collegept.org.

Examples of Consent

“Every human being...has a right to determine what shall be done with his own body.”
(Justice Benjamin Cardozo, 1914, Schloendorff v. Society of New York’s Hospitals¹).  
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1 Roy, DJ.  Williams, JR. and Dickens, BM. Bioethics in Canada. Prentice Hall Canada Inc., Scarborough, Ontario 1994: 116.