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Informed consent

Louis Malcmacher, DDS, MAGD

For more on this topic, go to www.dentaleconomics.com and search using the following key words: informed consent, risks of treatment, treatment acceptance, Dr. Louis Malcmacher.

When was the last time you had to go to a physician’s office, hospital, or medical lab for tests or some kind of procedure? I’m sure one of the first things you were given was a bunch of forms to fill out. These usually include a medical history, insurance claims that need your signature, and a couple of other pages with a lot of fine print that no one bothers to read. You were asked to sign on the bottom. When you visit a medical office you actually want to fill out these forms as quickly as possible, because, like all of us, you are busy and you are in a rush. You know the sooner you get these forms completed and back to the receptionist, the better your chances of being called in quickly.

One of the forms you signed was an informed consent that lists all the benefits and risks of the treatment or test you are about to undergo. In our dental offices, we are supposed to adhere to informed consent principles by letting patients know the risks of the procedures, the alternative options available to them, and the risks of no treatment.

Do you verbally go through these things with patients? Do you give patients a written informed consent? The answer in most dental offices is probably no.

Why don’t we use written informed consents in dentistry? The No. 1 reason that I hear from dentists when I lecture around the country is that the forms will scare patients, who will then decline treatment and drive treatment acceptance rates down. Nothing could be further from the truth!

We have been using informed consents in our offices for years. These are customized for every patient regarding the treatment they need and the requirements particular to their treatment. The entire process takes only a couple of minutes. The informed consent actually saves us time because we let it tell patients the risks associated with their treatment. We now have written proof that each patient was properly informed, and it makes our treatment much less stressful.

Here is a situation that just happened in our office and is repeated in many dental offices. About three years ago we did some veneers on a patient I will call Samantha. Samantha recently revisited our office because one of her veneers had a severe fracture and half the tooth was missing. I told her that the appropriate treatment would now be a crown, but she didn’t have time to stay and left the office.

A couple of days later she called our office manager and stated she had spoken to another dentist, who told her that we absolutely should stand behind our work and she should not be charged for the crown. The other dentist told her this is common practice.

I will leave the topic of how wrong it is for dentists to quickly judge one another without all the facts for another column, if that in fact did happen. I took the opportunity to go back and review her chart. Lo and behold, clearly written on her informed consent were all the options given to her at the time. She explicitly chose veneers knowing the benefits and risks based on her clinical situation.

I did not have to rely on my memory or written notes that the patient could have claimed I inserted later or without her knowledge. I had a clear document with the patient’s initials and signature on the informed consent.

Feel free to go to http://www.dentistryiq.com/index/display/article-display/6528720697/articles/dentisryiq/practice-management/patient-relationships/2011/05/consent-form_example.html to download a copy of the informed consent that we use in our office.

Every patient should sign an informed consent for every procedure — from operative to implants to facial esthetic treatments such as veneers and Botox. Patients are used to signing informed consents anywhere else they have treatment. Having a firm informed consent policy will save you money, time, and stress, and it lets patients know that you are a true health-care professional.

Dr. Louis Malcmacher is a practicing general dentist and internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for CLINICIANS REPORT, Dr. Malcmacher is the president of the American Academy of Facial Esthetics at facialesthetics.org. Contact him at (440) 892-1810 or email dryowza@mail.com. His website is www.commonsensedentistry.com, where you can sign up for a free monthly e-newsletter.

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DE Magazine
November 2014
Volume 104, Issue 11
1411DE_C1