Dental Protection’s dentolegal expert Dr James Foster answers your questions about consent.
Q: How do we check our patients have really understood what we have told them? How do we ensure they don’t forget?
A: Checking patient understanding is a clinical skill and has been written about at length in dental literature. One method would be to ask a patient to reflect back to you what they have understood about the information you have just put to them. We offer several courses (for example, Mastering Consent & Shared Decision Making) that share more advice and practical tips on obtaining valid consent.
Q: Is it OK to take consent for a multi-visit course of treatment once, or do we need to take consent for each item of treatment?
A: The clinician must go through the consent process for each stage of treatment, and document each discussion in the clinical records. This ensures that the patient understands all of the treatment options, including the risks and benefits of each option, so that they are able to make an informed decision on each stage of treatment.
Q: What should I say when patients ask me ‘What should I do’?
A: Although it might be easy to simply tell the patient what you think is the best option, it is ultimately their choice, and that choice must be freely given. In circumstances where a patient wants the dentist’s opinion, it is important to be able to show that the you have gone through the consent process, ie, discussing the different options including the risks and benefits of each, and then providing your opinion (which you should be able to justify) as to what you feel the most suitable option is for the patient.
Q: Is a patient information sheet with a treatment plan and a consent form sufficient to demonstrate valid consent?
A: Completed consent forms provide some evidence that the consent process was undertaken but mean little beyond that – it is important to realise that they do not constitute proof that the consent was valid. If there is any dispute over whether valid consent was obtained, the key issue will not be whether the patient signed a form or not, but whether they were given all the information they needed to make a considered decision. It is, therefore, crucial that the essential elements of discussions with the patient are documented in the dental records.
The notes do not need to be exhaustive but should state the nature of the proposed procedure or treatment and itemise the risks, benefits and alternatives brought to the attention of the patient. Any particular fears or concerns raised by the patient should also be noted alongside recording how these were addressed.
Q: Who should complete the consent form – the person doing the procedure or the dentist who leads the team?
A: The person intending to carry out the procedure needs to be the one who obtains consent (and I stress obtains consent through discussion and note making rather than merely filling out the consent form and requesting the patient to sign). The treating clinician is the one who is appropriately competent to carry out the procedure that is proposed, (ie: have sufficient knowledge of the proposed procedure and understands the risks involved),therefore they should be the one to have the conversation with the patient and answer any questions which may be posed as a result.
For more information about Mastering Shared Decision Making or any of our other workshops, please visit our Workshops page.