Informed Consent: Obtaining Consent by Telephone
When a patient's legally authorized representative (i.e., medical power of attorney) is available to participate in an informed consent discussion but is not physically present, consent by telephone may be obtained. However, best practice is to have the informed consent discussion occur in person.
Telephone Call Participants
When pursuing telephone consent, in addition to the practitioner, at least one other designated employee must be present on the telephone to witness the consent conversation and subsequently sign the applicable document(s).
The conversation must begin by identifying and verifying the parties on the telephone call. Explain to the legal representative that an employee is on the call to serve as a witness to the conversation.
Verify that the legal representative has the authority and is willing to make health care decisions on behalf of the patient who lacks decision-making capacity.
The practitioner who will be performing the procedure must obtain the informed consent. To the extent possible, the practitioner must provide the patient's legal representative with the same information that would be provided to the patient, e.g., the same level of disclosure and an opportunity to discuss the information provided. Elements of the informed consent discussion are listed below:
- the nature of the patient's condition, the patient's diagnosis and the proposed treatment(s) to be performed
- the risks involved with the proposed treatment(s)
- the benefits of the proposed treatment(s)
- if the proposed treatment/procedure is irreversible
- the likely result for the patient if no treatment/procedure is performed
- available alternatives to the proposed treatment(s) and their risks and benefits
- the opportunity to ask questions and have those questions answered to the legal representative's satisfaction
- the legal representative's demonstration, thru their own description of the proposed treatment/procedure, that they fully understand the treatment/procedure for which they have consented [Teach Back]
The practitioner obtaining consent must document in the patient's medical record:
- the name of the legal representative from whom she/he obtained consent
- the exact time of the conversation
- the name of the witness to the conversation
- the reason why the consent was obtained by telephone
- the elements of the consent conversation
- the representative's understanding and agreement to proceed
If the legal representative objects to the proposed treatment/ procedure, document the objection in the patient's medical record.
Informing the Patient
Although the patient may lack decision-making capacity, when feasible, the practitioner must explain to the patient the treatment or procedure for which the legal representative has consented. The patient should have the opportunity to ask questions and have their questions answered to their satisfaction. The patient should demonstrate to the practitioner their understanding of the treatment plan/procedure. Document this discussion in the patient's medical record.
Informed Consent Form
After the telephone discussion, the consent form must be either faxed or mailed to the legal representative so that he/she can sign the consent form and return it prior to the procedure. The practitioner and the witness should sign, time and date the informed consent form when returned.
MMIC Practice Tip, Informed Consent: A Process for Building Patient Confidence
Medical Mutual Insurance Company of Maine's "Practice Tips" are offered as reference information only and are not intended to establish practice standards or serve as legal advice. MMIC recommends you obtain a legal opinion from a qualified attorney for any specific application to your practice.