Asking for documentation of consent for every examination or visit would be a major shift in practice and a large burden on already busy physicians, without much if any benefit to patients. If a patient books an appointment because of a sore throat, it strikes me as quite over the top that there would have to be an informed consent discussion that I documented prior to looking in their throat. Implied consent should be kept as a concept, though physicians should be conscious of a patient's right to stop at any point, and the requirement to document the consent should be limited to specific circumstances, such as procedures. There can be a middle ground for items such as breast or genital exams, such as confirming that it is OK to proceed, or that they expect to have a Pap smear done etc, but I feel that is largely handled in the later section of the proposed standard. Documenting this in the middle of a complete physical, for example, seems to me to be too high of a burden, when a simple, "Is it OK if I do a breast exam now?" would generally suffice.