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A Young Practitioner's checklist for consent

Obtaining consent in dentistry is a key skill in ensuring patient satisfaction and avoiding claims and complaints.

In order for consent to be valid, the patient should be aware of the purpose, nature, likely effects, risks and chances of success of a proposed procedure, and of any alternatives to it. The fact that a patient has consented to a procedure on one occasion does not create an open-ended consent that can be extended to subsequent occasions. Consent must be obtained for specific procedures, on specific occasions. It is a conversation with the patient, rather than a form that is completed without any discussion or interaction between the patient and the practitioner.

When assessing whether you have a valid consent, before proceeding with the treatment you should ask yourself:

  1. Is the patient capable of making a decision? Is that decision voluntary and without coercion in terms of the balance/bias of the information given, or the timing or context of its provision?
  2. Does the patient actually need the treatment, or is it an elective procedure? If an elective procedure, the onus upon a clinician to communicate information and warnings becomes much greater.
  3. What do I think will happen in the circumstances of this particular case, if I proceed with the treatment? Have I communicated this assessment to the patient in clear terms? Can I give an accurate prediction? If not, is the patient aware of the area(s) of doubt?
  4. What would a reasonable person expect to be told about the proposed treatment?
  5. What facts are important and relevant to this specific patient? (If I don’t know, then I am probably not ready to go ahead with the procedure anyway.)
  6. Do I need to provide any information for the patient in writing? Has the patient expressed a wish to have written information? (Am I relying on commercial marketing material produced by manufacturers and/or suppliers? If so, is this information sufficiently balanced in the way it is presented?)
  7. Do my records accurately and sufficiently reflect the details of the communication process? Will they allow me to demonstrate – perhaps many months or years from now – what information was given to the patient, on what terms, and what was said at the time?
  8. Does the patient understand what treatment they have agreed to, and why? Have they been given an opportunity to have any concerns discussed, and/or have their questions answered?
  9. Does the patient understand the costs involved, including the potential future costs, in the event of any possible complications?
  10. Does the patient want or need time to consider these options, or to discuss your proposals with someone else? Can/should you offer to assist in arranging a second opinion?
  11. If you are relatively inexperienced in carrying out the procedure in question, is the patient aware of this fact? Are they aware (if relevant) that they could improve their prospects of a successful outcome, or reduce any associated risks, if they elect to have the procedure carried out by a specialist or a more experienced colleague?
  12. If the technique is relatively untried or of an experimental nature, has the patient been made aware of this? Included here are any procedures for which the evidence base is limited or absent.

This information is taken from the Dental Protection Advice Booklet: Consent and is a reminder for day-to-day practice.

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Dental Protection members who are also ADAWA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDANI, which is available in accordance with the provisions of ADAWA membership.
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