Case study: Informed consent

29 february 2024 ginger cat resting on a cushion background a cat was taken to a veterinarian with symptoms including dehydration, severe diarrhoea and an enlarged abdomen that was causing pain when touched the veterinarian performed an initial examination and considered several causes including an infection, feline infectious peritonitis (fip); and non infectious causes including inflammatory bowel disease and neoplasia as a result, the cat was hospitalised for further diagnostics and treatment the cat’s owner and the veterinarian knew each other and were in daily contact about the cat however, the cat’s stay in hospital was prolonged and consent to perform supportive treatments along with its ongoing care and expected costs, was not obtained the complaint the cat’s owner referred their concerns to the vet council, which relayed them to its notification review group (nrg) the nrg screens notifications to identify areas of concern and see if further action is required the process is less formal than the complaints assessment committee (cac) and has a focus on education and guidance to improve future practice the cat’s owner was concerned about the informed consent process followed by the vet they were particularly concerned that the veterinarian did not communicate the cost for treatment or testing; did not advise when euthanasia should be considered; and did not seek additional consent for treatment while the cat was hospitalised how it was managed informed consent is an interactive process between the veterinarian and client the code of professional conduct requires veterinarians to obtain the clients informed consent before proceeding with a proposed treatment or course of action in situations where either the condition of the animal or the treatment options change, further client consent is required in the nrg’s view, the veterinarian adequately sought and documented the initial client consent through their conversation with the client, and the signing of a clinic consent form however, the veterinarian should have sought further consent for the ongoing care and supportive treatments that were administered while the cat was hospitalised the nrg acknowledged that the situation was complicated because the veterinarian and client were well known to each other and in communication about the patient on a daily basis ideally, the veterinarian should have documented their discussions with the client in the clinical records where possible, veterinarians should document a summary of any relevant communication that takes place to arrive at a treatment decision if verbal consent is given, it must be documented in the patient’s clinical record the veterinarian acknowledged that they provided an estimate for the initial treatment, but did not provide an estimate for ongoing diagnostics, hospitalisation, and monitoring in their response, the veterinarian outlined several steps they had taken since this case, including providing a handout to clients with a breakdown of recommended diagnostics and their associated costs; implementing a new standard operating procedure on keeping clients informed; and ensuring that both face to face and phone discussions with clients are documented in clinical records the veterinarian provided evidence to show the nrg that these changes had been discussed with the other clinic staff learnings for the profession while some aspects of the veterinarian’s communication had fallen short of the standard expected of the profession, the nrg felt the veterinarian had reflected on the complaint, and taken a proactive approach to improving protocols and processes at their clinic the nrg commended the insight shown by the veterinarian, noting that vets must ensure clients have enough relevant information to make an informed choice about treatment options, including the costs associated with treatment where appropriate, they must also provide information about any post treatment requirements and their costs the nrg was satisfied that the changes made by the veterinarian mitigated the risk of a similar issue happening in future the nrg asked vet council staff to follow up with the veterinarian six months later to check in – which was done for more information see our technical advice about informed consent docid\ kdpn iaz6qxswuwsp1h c