Informed Consent

What is it?

Informed Consent is permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Google’s definition lays out a few of the ground rules of informed consent, namely “permission granted” and “full knowledge.” There is no consent at all if these two aspects do not play a part. All dental professionals have a responsibility to divulge all pertinent information to their patient before performing a procedure. There are some exceptions, but we will get into those later. It is important to focus on patient education when it comes to consent because consent does not start with the moment of the procedure, it begins the moment the patient walks through the door and has their very first discussion about their oral health with the dentist.

First, we should get to know the different types of consent. There are two types to consider and specific rules to follow for each.

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Implied consent

This is consent usually ascertained by the actions of the patient. If the patient opens his or her mouth for an examination, they are granting you permission to perform that examination. The Dental Recordkeeping Guidelines manual suggests that implied consent is only sufficient if:

The patient voluntarily comes to the dentist’s office, usually for a simple examination.
The procedure is non-invasive and poses no risk of harm to the patient.

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Express consent

The rules for express consent focus solely on your relationship and the conversations you have with the patient. It is consent that is either written or oral. The The Dental Recordkeeping Guidelines manual states that this type of consent should be obtained for:

Any treatment that poses a potential risk to the patient, even if the risk for complications is low.
Any procedure, either as simple as a filling, or as complex as oral surgery, extraction or prosthetic rehabilitation.

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What makes consent informed?

Informed consent cannot be considered informed if the dentist does not deliver the right amount of information. According to the The Dental Recordkeeping Guidelines manual, informed consent is “based on the rights of each person to determine what will be done to his or her own body.” Informed consent guarantees that the patient has the right to refuse or consent to treatment. The patient also has the right to withdraw consent from treatment. It is important for the patient to be on the same page as the dentist and that means knowing the risks and benefits, but the only way to truly understand those certain risks and benefits is by being provided information about the diagnosis or problem noted and the treatment alternatives (even those not provided by the dentist). Your patients also need to be informed of the estimated costs of each option, the nature and purpose of each treatment, and the possible consequences of declining treatment.

What to do

In the case of a dispute, regarding informed consent comes up, the question becomes: Can you as the dental professional prove that the right amount of information was delivered? There are two aspects to consider for you to answer this question with a straightforward “yes.”

The recordkeeping aspect

Delivering the right information means more than just developing a dialogue between you and your patient, it means properly recording the discussion in your notes so that you have them to show as incontrovertible proof that the discussion actually occurred. Be accurate, be detailed, and make sure to date and sign the recorded notes as well. Keep in mind what Robert Tighe, a litigation lawyer, says in Bruce Glazer’s interview, “Some form of a written document is essential if at some point in the future a dispute regarding informed consent should arise.”

The patient aspect

You have a responsibility as a dental professional to adequately inform the patient of any procedure you are planning to perform. Informed consent has become a patient-centered concept, a dialogue with patients that “begins at the first visit to the office and continues as treatment progresses. However, before the dialogue can happen, it is imperative that you know your patient on a personal level, allowing them to open up without feeling the urge to withdraw or impress. A patient can’t make a decision without knowing all the facts, but their decision can be further hindered by not being able to ask questions that need asking or even question certain answers you give. Remember that all patients are different and if you know your patient well and they know you, you can then tailor the provided information to their specific needs.

Do you have any comments or suggestions on this topic? Let us know in the comment section below. We’d love to hear from you, and please feel free to peruse the links below for more information.

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