3 January 2012

Q. I was thinking of creating a series of consent forms to be stored on the surgery computer and asking patients to sign the one appropriate to their treatment prior to starting the work. What advice can you give me?

In general, although consent forms can sometimes be helpful it is important to ensure that they are used as the culmination of the consent process rather than a replacement for it. Consent is a process of explanation, discussion and agreement, rather than a single event and is certainly not characterised by a signature on the bottom of a consent form. Indeed in UK law the presence of a signature does not categorically mean that the patient has given their consent.

It is important to ensure that the patient is fully aware of their treatment before it is started. The dentist needs to explain ahead of time, the risks, benefits, pros and cons and most importantly any other alternative treatments that may be available, both in the practice and elsewhere. For example, when a clinician discusses the provision of an implant to a patient they must also mention other possible treatments (bridge, denture etc) including the possibility of no treatment at all. The implant may be the clinician’s preferred option but the alternatives also have to be discussed.

Similarly, the patient needs to be aware of what implications the proposed treatment might have for them personally. For example a patient who is having a tooth removed and replaced with a denture needs to know that the initial denture would be regarded as temporary in nature and may well require some adjustment or even replacement at a later date. If the patient works in the public eye then this looseness may not be acceptable to them whereas for another patient it may not represent a problem. Any failure to inform the patient adequately might well result in an allegation that valid consent has not been obtained.

You also need to be careful as to the terminology that is used; keep the wording simple. There is a further difficulty with using a consent form in that you do not know whether the patient can read or for that matter understand the information that is being provided for them. This is made more difficult when the consent form contains what might be referred to as dental “jargon”. For obvious reasons if a clinician relies on a consent form to indicate that a patient has agreed to treatment and they do not understand some of the wording on the form, then the consent would not be regarded as valid. The longer and more complicated the form the more likely it is that such an allegation would arise.

In addition many patients are often extremely suspicious of any form that is being placed in front of them that they are asked to sign before treatment is provided. Such a “legalistic approach” from the clinician is often interpreted as being a lack of trust and can therefore place the patient on the defensive. The more forms a patient is presented with, the more likely this is to occur.

The clinician cannot rely on the presence of a signed consent forms to ensure that the patient has given their consent. If however the information is provided as an advice leaflets this is an entirely different matter. As such then if you are to provide implants for a patient then you would be expected to discuss the treatment carefully with the patient and ensure that they understand. Most clinicians would not begin the treatment that day (even if it was feasible to do so) and would suggest that the patient takes the information home and think about the treatment before making a decision, (known as a cooling off period).

Providing an information leaflet to a patient at this point in time, is obviously very helpful and allows the patient to undertake some “homework” to satisfy them about the treatment.

Some patients for obvious reasons will not read the information form, but that is not to say that it should not be given to them. Most importantly however the dental records should reflect in as much detail as possible the discussion that has taken place and the fact that the information leaflet has been provided. If these elements are in place and the patient agrees to the treatment, then it is highly unlikely that any criticism will be made.

The only exception to this rule would be in relation to the provision of sedation where a clinician is required to obtain a signed consent form before proceeding. There are certain key elements (that are a regulatory requirement) that must be included within the consent form, most notable of which would be that the proposed treatment should be clearly indicated in sufficient detail on the form in plain English.

Click here to read DPL advice booklet on consent.

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