Kelsey Marksteiner: I don’t, because as a dietitian, we can’t “treat” anything. There would be nothing to inform them of. There’s no consent that I need for what I’m doing. I imagine Chris probably does, but that would be a better question for him.
I have people sign a form. Let me see if I can pull it up. Essentially it just says, like, “I am a dietitian. I can’t diagnose or treat any condition. This is just for general health purposes,” that sort of thing. Let me see if I can find that contract. Here we go. I’m just going to read this to you guys because I can’t share this exactly. Essentially I list out the services that are provided, and then I say, “I, Kelsey Marksteiner, am not a physician. As a registered dietitian, I do not diagnose or treat disease. I work with my patients to create a healthy lifestyle and diet that will support their needs. I can provide recommendations for laboratory tests and supplements but request that you have them done or get them approved by your primary care practitioner.” Then the client fills this out. “I, [client name], understand that information provided on the relationship between nutrition and health is not meant to replace medical treatment for any health problem or condition. Any supplements recommended as part of this program are not intended to treat or cure any health condition and are optional on the part of the client.” Then I just say, “You should always consult your physician when making any diet or supplement changes.”
That’s going to be different for anybody who acts more as a primary care practitioner. As an ancillary health practitioner, that’s perfectly acceptable because really I want them to use their doctor as their actual primary person. Now, in practice, I have a lot of people who are afraid of doctors, they’ve had terrible experiences with doctors, and they don’t want to see a doctor. I do always recommend to them that they work with their doctor and get any supplements approved by their doctor. In reality, people don’t, of course. That’s just not something that people do, but you have to at least tell them and make them aware that this is something they should be doing. A lot of the things that I’m recommending … I, of course, am recommending things that are really low-risk, high-reward kind of stuff, so there’s not a whole lot to worry about here. That’s the way that I choose to do it.
I could do informed consent because I guess technically, in a way, sometimes people will come to me for SIBO or something and I’m giving them herbal antimicrobials, which really could be constituted as treatment, but as a dietitian, supplements are well within our toolhouse, and so there’s sort of a blurry line there. It’s hard to know whether it’s just helping a health condition or if it’s actual treatment. I would probably say it’s more treatment for sure, but again, that line is a little bit blurry. At least at this point, since no one has come out and said that that is not appropriate for a dietitian, it’s something I still do. Probably within all of your own practices, there are going to be these gray areas like that, where you’re not really sure. You have to make your own risk assessment as to whether you’re comfortable with recommending those kinds of things. You could use an informed consent form, but I would almost think that that sort of makes you more liable in a way because then you’d be definitely saying that what you’re doing is treatment. I don’t what kind of practice you have, but it’s really going to depend.
Like I said, I imagine Chris probably has something like an informed consent form, but I definitely would ask him as well.