What I also understand is that in the popular press, on Google, throughout the literature, there is an association whether it's a temporal association, whether it's a statistical association, there is an association between chiropractic care and vertebral artery dissection. There is also an association between medical care and vertebral artery dissection. That's a given. Now it's very important that we understand that association is not causation at this point. The most re- cent literature, 2016, the most pertinent literature that proceeds that, Kosloff and Elton in 2015 and all the way back to Cassidy in 2008 do not say there is a causal relationship. In fact, they deny a causal relationship between chiroprac- tic care and vertebral artery dissection. Nonetheless, in the process of informed consent to air on the side of caution and to discuss this potential association is very important and very useful for the patient to be fully informed and for you as a chiropractor to be honest and straightforward with the patient about this association. This also serves to pro- tect you and has the potential to remove cause of action from the table if any- thing unfortunate happens down the road. Important in the process of in- formed consent is the delivery. Informed consent is not just a slip of paper that they sign at the front desk and it's put into file and that's it. The patient should always have an opportunity to discuss with you any questions or concerns that they might have. Not with the front desk but with you. To perfect the delivery of your informed consent is very important in the pro- cess as a whole. The third step in the process is to make sure your records re- flect the informed consent discussion. The documentation was presented to the patient. The patient signed it. You discussed it. They didn't have any ques- tions. You sign it, date it and move on. Obviously maintain a copy of informed consent signed by the patient in the patient records and then over time, up- date your informed consent as the literature involves. If you don't know where to go to get a good informed consent statement or information about that, I would refer you back to ChiroSecure. ChiroSecure has developed a very useful informed consent packet that not only provides you with an informed consent statement for your consideration but also provides you with the background literature and summary form to be able to fully understand and appreciate the nuances of the informed consent and to be able to explain to patients the information. Continuing on the theme of what we can learn from this experience, this is a great opportunity for each and every one of us to review the current and the most timely literature on this subject. There are 3 pieces of literature that I'd like to chat with you about this morning. The first is Cassidy from 2008. The second is Kosloff and Elton from 2015. The third is Church and Associates from 2016.
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