Informed consent means giving your formulation, your recommendation, and the benefits and risks, including the risk of not treating: doing nothing is a choice with consequences. Name the specific fears and harms plainly, whether that is memory with ECT or dependence with benzodiazepines, and warn when a requested treatment is unlikely to work. The same risk-and-benefit talk applies to paperwork such as disability leave.
How we use it
Your job is to give your formulation and your treatment recommendations and to explain the benefits and the risks, and the risks include not taking the medication.
“Your job is to give your formulation, give your treatment recommendations, and explain the benefits and the risks. And risks include not taking the medication”
1:01:15Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Patients need to know that doing nothing is a treatment option. They can choose not to treat their illness, but letting it run its course can have profound effects.
“it's critical for people to know that doing nothing is a treatment option. They can choose not to treat their disease, but doing nothing and allowing a disease process to run rampant or run its course can have profound impacts”
48:16ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026Guest episode Advise patients about the risks and benefits of disability paperwork the same way you do with medications.
“When we give disability paperwork, you should also advise the patient in the same way that you do with medications about the risks to the benefits”
38:36Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025
Talking to patients
Before a benzodiazepine, say it plainly: this is a controlled substance that causes addiction, withdrawal, executive function and memory problems and sedation, it probably slows progress in psychotherapy, and the next doctor may not continue it.
“You're going to be on a controlled substance that causes addiction, withdrawal, executive functioning problems, memory problems, sedation, and it probably slows your ability to improve yourself in the psychotherapy as well. And I might be happy to give this to you, but I can't say that if you have to change doctors”
48:38Psychiatrist's Guide to Anxiety Medications: First Line to Last ResortJun 2025 With ECT, the biggest resistance is fear about memory, so have explicit conversations about what those risks are.
“The biggest resistance for most people is the fear around memory and memory concerns. Having explicit conversations around what those risks are is really important as far as an informed consent is concerned”
42:15ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026Guest episode The same risk carries more weight when the condition you are treating is less serious, or less responsive to that medication. That part often gets lost in the conversation.
“a part that gets lost in the conversation here is that even if one medication carries the same risk across the population, that risk becomes more salient. when the condition you're treating is either less serious or less responsive to that medication”
8:53Psychiatrist's Guide to Anxiety Medications: First Line to Last ResortJun 2025
Pitfalls and myths
If you offer or agree to an ineffective treatment and do not warn the patient, you are liable if something bad happens.
“If you offer or agree to an ineffective treatment and you don't warn that, then you're liable if something bad happens”
1:03:45Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Actively suicidal, depressed patients may hear that general anesthesia carries a chance of dying and take that as their reason to sign up. Consent with these patients takes some creative conversations.
“I have had to have some creative conversations around informed consent for individuals who had depression and were actively suicidal and they hear that under general anesthesia there's a chance of dying and that's their indication that they want to sign up”
40:01ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026Guest episode
It also comes up on
- AntipsychoticsWith a refusing patient: "I know you disagree, but we've talked about the risks and benefits, and I think it's indicated. It'll be at the pharmacy waiting for you."
- Major depressive disorderMen with verified low testosterone and depression might talk with their primary care doctor about the risks and benefits of supplementing. The trials were in verified low levels, not beyond normal.
From these episodes
- Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 · 2 points
- ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026 · 3 points
- Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025 · 1 point
- Psychiatrist's Guide to Anxiety Medications: First Line to Last ResortJun 2025 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.