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Whenever I get a checkup with my eye doctor, they have me sign a consent-to-treat form. I never gave it a second thought. This last visit, though, the front desk attendant was distracted when I arrived. They knew I was there waiting, but forgot to have me sign. They called me for my appointment, I finished, paid, checked out with the same attendant at the desk, and left.

Now I'm wondering. Does it matter that they forgot to have me sign? Obviously I consented to being treated because I'm an adult and I willingly went with the doctor, so what's the need to have me sign? Is there some reason that an optometrist in the US would have me sign for my consent to treat at every visit when my implied consent is so obviously given? Is there some liability that they reduce by getting my physical signature?

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    A "checkup" is just an observation, not a treatment, though, right? There is a difference between going to have your eyes observed, and going for a treatment. The "implied consent" for a treatment might not be as obvious as you think. Just because you go to a medical practitioner does not mean you implicitly give them all rights over your body. Although I do find it ridiculous that they have you sign a consent form before you actually see the doctor. At this point you couldn't even know what it is that you're consenting to.
    – Stef
    Oct 12, 2022 at 8:09
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    I'd say it's more like a treatment because visits to the optometrist always result in a new prescription for corrective lenses
    – nuggethead
    Oct 12, 2022 at 9:41
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    Yes, but a visit to the optometrist can also result in "I need to inject this colorant into your eye to examine it in more detail", and just walking into the optometrist's office does not give implicit consent to get stuff injected into your eye. This is why signing the document with the secretary before you actually see the optometrist is a bit ridiculous - you should still be asked for informed consent by the optometrist for each specific procedure, especially invasive procedures, no matter what you signed beforehand.
    – Stef
    Oct 12, 2022 at 9:51
  • Does the consent form have lots of terms and conditions and warnings and disclaimers? i.e. you may be consenting to being treated simply by making the appointment, but not necessarily have been aware of the details of what they were doing, possible side effects, that they take no responsibility for accidentally poking your eye out, etc.
    – komodosp
    Oct 12, 2022 at 10:53
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    Every word in a contract is there because someone once got in trouble by leaving it out. A verbal contract is worth the paper it's printed on.
    – keshlam
    Oct 13, 2022 at 5:02

3 Answers 3

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If they do a treatment which you didn't consent to and harm you they risk being sued. As such, they get you to sign a consent form to prove you agreed to the treatment and were informed about what was going on and any material risks.

They had implied verbal consent from you which is enough legally, but there's a risk that if it went wrong you could claim you didn't consent, they lied about what treatment you had, and they illegally did it.

As an example, they often drip something into your eye which can sometimes cause blurry vision for a while. If you had blurry vision after and crashed your car you could theoretically sue them because you say you didn't consent to that and they have no proof you did.

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    And may need it to show your insurance co that you were actually treated and not a phantom patient they were billing for. Oct 12, 2022 at 0:30
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    In other words, it isn't legally required but is a matter of have a system for proving that what happened really did in a way that is hard to question.
    – ohwilleke
    Oct 12, 2022 at 1:15
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    I remember being wheeled into an ice-cold OP while gasping with pain and unable to move, and I had to hold a pen and put my mark on a form before they'd snip me open. BUT if the worst had happened they didn't want to held liable, despite doing all they could. The world is a sad place, wicked lawyers everywhere. I would like to see that signature - would it hold up in court?
    – RedSonja
    Oct 12, 2022 at 12:44
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    If you had blurry vision after and crashed your car you could theoretically sue them — surely driving off with blurry vision is not something any court would be OK with?
    – gerrit
    Oct 12, 2022 at 15:20
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    @RedSonja generally in an emergency a medical professional can do procedures to save your life without permission. There are also good Samaritan laws that allow doctors to provide assistance in less than ideal conditions if there is an emergency.
    – Neil Meyer
    Oct 12, 2022 at 20:32
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One vital word is missing from here: informed consent.

This means the health care provider has given you the relevant information about risks etc., which is precisely the sort of thing that you wouldn't otherwise know, so that when you decide, you know what you're actually choosing to consent to. Such consent should be properly documented, particularly what/how/when information was given.

Uninformed consent is legally invalid.

See for example, positions of the AMA, NHS, CMPA, ACSQHC, NZMOH. This is universal, per WHO.

The documentation serves multiple purposes, including at least:

  1. Protection in the case the patient later decides to claim that they didn't consent (or their expressed consent was invalid).
  2. Proper medical records for future reference, either by the same provider or a different one.
  3. Following procedural rules that most, if not all, physician regulators require as part of professional codes of conduct.

The necessity of having written paperwork is proportional to the risks involved in the procedure. Taking blood pressure? Nobody is going to care*. Putting stuff in someone's eye that does have possible side effects and limitation on driving? Yep.

*: And it's not like that's risk-free. You can turn a blood pressure cuff into a tourniquet and cause damage, but at that point you just sue the device manufacturer for defect and/or provider for blatant malpractice, regardless of consent.

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  • If the sole reason for this paperwork is informed consent, please, link to a source which shows that consent is not deemed "informed" until such a paper is signed. If there is no requirement, then this doesn't answer the question.
    – wrod
    Oct 13, 2022 at 17:29
  • @wrod You're presuming there should be only one reason for paperwork. In the end it's always CYA, and the biggest risk is the patient claiming after the fact that they "didn't consent" or "didn't understand what they consented to". The documentation partially protects against that, and is ethically required by multiple regulators for that and other reasons. There is no legal requirement.
    – obscurans
    Oct 15, 2022 at 0:58
  • I am not making the assumption you suggest I am making. You can see my answer to this question for another reason which I suggest such paperwork may have. But I think my point stands even without my answer. My point is that I don't see why informed consent has to entail written consent. If there is authority which makes it so, I would that premise. But I don't think I can accept it on its face.
    – wrod
    Oct 15, 2022 at 1:02
  • It does not and I make no such claim. Uninformed consent is legally invalid. Patient may claim that they did not consent due to, among other reasons, lack of information invalidating consent. Documenting provision of such protects against such claims, despite no legal requirement to do so. The world would be a sad place if physicians did the right thing only under direct legal threat.
    – obscurans
    Oct 15, 2022 at 1:04
  • so it is legally acceptable to claim that the patient was apprised of their even if no paper trail documenting this process exists? I fully understand that it would be a more difficult claim to make, but just to be clear "informed consent" can happen without a written consent to treat? My question is whether this is about prudence or compliance.
    – wrod
    Oct 15, 2022 at 1:09
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All medical providers have to have insurance. Malpractice insurance is often reported to be very costly. As a potential strategy for reducing malpractice claims, the insurance companies could give a discount to all the doctors who agree to receive such a written consent from all the patients.

The rituals setup by insurance companies are often meant to reduce chances of small-probability high-cost events.

Consider what happens if insurance companies have calculated that

  • it will, for example(!!!!), remove 1 in 50,000 chance that someone will get treated for something other than what they agreed to be treated for
  • the savings from not paying out the malpractice suit would be higher than the discounts these companies give to all the doctors for agreeing to this ritual

In such a scenario, it's a good practice for the insurance company to sell such a discount. If a doctor performs a wrong procedure and they don't get a consent form, they won't have insurance and they will be on the hook (no insurance) for the malpractice claim. If they perform the right procedure, and their malpractice insurer doesn't find out, none will be the wiser.

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