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2.01.08 Issue #308 Forward This Newsletter To A Colleague

Carol Tekavec
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Obtaining Informed Consent- Why Should We Bother?

Good clinical practice and informed consent are inseparable.  Patients need to understand their treatment in order to appreciate the services they are receiving.  Dentists need to be able to present their recommendations in a coherent fashion to encourage treatment comprehension and acceptance.

 Patients who do not understand their dental services are the same patients who end up complaining about treatment outcomes and fees. All of us know of cases where a patient who is not paying his/her bill decides to sue a dentist for malpractice.  While the issues surrounding malpractice are different than those involving informed consent, there is a common thread.

If a lawsuit claims malpractice and lack of consent, the dentist faces a “double jeopardy” situation.  Without written consent, the patient may be able to successfully assert that he did not understand his treatment and did not give his permission to receive the services in the first place.  Proceeding with treatment may be broadly construed by the court as “battery” or more likely “negligence”.  Individuals have the right to decide what will be done to their bodies.

Conversely, patients who have signed a treatment specific informed consent form will likely be required to explain in court why they signed a form that they did not understand.  If the consent form is laid out in easy-to-understand terms with a simple format, the patient will even have a more difficult time in backing up that assertion.  So, obtaining a written consent is important, both for treatment acceptance and risk management.

What is Informed Consent? Informed consent is a process, not just a form. However, an actual treatment-specific, written form or at the very least, detailed notations in a patient’s progress notes (with the patient’s signature next to the consent entries); can verify that consent has taken place. Many offices prefer forms, because, it is more likely that all aspects of a procedure will be discussed. 

As for a legal definition of consent, there are many. One definition is, “An agreement to do something or to allow something to happen, made with complete knowledge of all relevant facts, such as the risks involved or any available alternatives.  For example, a patient may give informed consent to medical treatment only after the healthcare professional has disclosed all possible risks involved in accepting or rejecting the treatment.  A healthcare provider may be held responsible for an injury caused by an undisclosed risk”.

Do we have to have a form signed for everything? According to many legal advisors, written consent should be obtained for any service that is not commonly done or easily understood.   In light of this advice, the Informed Consent Booklet of 31 treatment specific consent forms was developed.   The forms are single page, easy to understand, and follow the accepted  “consent format” of treatment recommendations, risks of that treatment, alternative treatments, risks of the alternatives, consequences of doing nothing, and the fact that fees have been discussed. A section on each form is provided for the patient and a witness to sign. Separate forms are included for such varied procedures as Implants, Periodontal Scaling, and Tooth ColoredFillings". 

Why should we bother providing a consent form for a tooth colored “filling” or perio scaling?  We do these services all the time and everyone understands what they are. Are you sure? Have you ever had a patient complain that a tooth colored “filling” is sensitive, seems a little darker over time, or shows some staining at the margins? Many patients do not understand the possible limitations of tooth colored fillings.  If they are not happy, they may not pay their bills. 

Have you ever had a patient complain that she is tired of paying so much for her “cleanings”?  (In fact, complaints to State Dental Boards concerning “cleanings” are on the rise.) Obviously, many of these complaining patients are not receiving “cleanings”, but periodontal scaling and subsequent periodontal maintenance.  

The issue probably lies in the fact that the patient does not really understand his/her treatment. The informed consent process can be the key to unlocking this lapse in communication.  While it is true that tooth colored fillings and periodontal scaling are procedures that are frequently performed, it is not true that they are always understood.  Educational brochures designed to answer frequent questions help the patient understand these dental procedures.

If we tell our patients about all of the “bad” possibilities that may occur with a treatment, they may not come back. It is not better to keep possible complications or problems a secret because of worries that a patient may not return for treatment.  If a patient receives treatment that results in a poor outcome due to an undisclosed, although not uncommon complication, the dentist will face a tough road should that patient decide to file a lawsuit.  The situation is very different when a patient has signed an informed consent form for treatment that results in a previously disclosed possible poor outcome.  In that case it is the patient who faces a tough road to prove that he/she did not understand the treatment. 

With 34 years in the dental field, Ms. Tekavec is the president and owner of Stepping Stones to Success.  She is a well known author and lecturer.  She has appeared at all of the nation’s top dental meetings, as well as providing programs for dental societies and study clubs.  Still practicing as a hygienist clinically, she is a consultant with the ADA Council on Dental Practice, and was the columnist on insurance for Dental Economics magazine for 11 years.  She is the author of the Dental Insurance Coding Handbook, and a best selling patient brochure series.

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