Informed consent & practice policies

Informed consent is a process, not a signature. The document exists so that the conversation happens and so that it can be evidenced; the conversation is what actually protects the patient. Read the limits of confidentiality aloud rather than pointing at a paragraph — a patient who first learns about mandated reporting on the day you make one has not been given informed consent.

The three elements

1. 1Capacity — the patient can understand the information and use it to decide. Where capacity is impaired, involve a legal guardian and document the basis for your judgement.
2. 2Information — what treatment involves, alternatives (including no treatment and medication), foreseeable risks, likely duration, and the limits of confidentiality.
3. 3Voluntariness — the patient is free to decline, to ask questions, and to withdraw. Court-mandated and employer-referred clients are consenting under constraint; name that constraint explicitly rather than pretending it is absent.

Limits of confidentiality — the ones to state out loud

• Imminent risk of serious harm to self
• Serious threat of harm to an identifiable other (duty to warn or protect; the standard varies substantially by jurisdiction)
• Suspected abuse or neglect of a child, an older adult, or a dependent adult, per your mandated reporter status
• Court order or subpoena — and the difference between the two
• Consultation and supervision, including who else may hear the material
• Insurance and third-party billing, which typically requires a diagnosis and may require records