Informed consent principles

Many dentists and staff members look upon the need for documentation of informed consent as just another issue to cause them trouble and take up time. With all of the other concerns demanding staff time, dealing with informed consent may seem like the "last straw."

Carol Tekavec, RDH

Many dentists and staff members look upon the need for documentation of informed consent as just another issue to cause them trouble and take up time. With all of the other concerns demanding staff time, dealing with informed consent may seem like the "last straw."

Documenting the informed consent of a patient need not become a stumbling block to efficient treatment. In fact, the informed-consent procedure and documentation can be incorporated very successfully into the patient`s initial treatment conference. Make it a part of the educational process that the patient undergoes when learning about his /her needed treatment and the options available.

How important is informed consent? It is very important to patient understanding and trust, as well as paramount in avoiding malpractice suits.

Informed consent parameters

Informed consent consists of a patient`s understanding of several issues surrounding treatment:

(1) Recommended treatment

(2) Risks of that treatment

(3) Alternatives to the first recommended treatment

(4) Risks of the alternatives

(5) Consequences of doing nothing

(6) Fees involved

(7) Questions answered

- No guarantees

" Written documentation

Implementing informed consent

Informed consent actually is a process, not a form. However, most dental offices today opt for informed- consent forms. The forms should describe all pertinent facts of a given procedure and provide a section for the patient`s signature as written documentation. A form ensures that all facts have been discussed, and a signature on the form implies that the patient understands these facts. Informed consent is very important, but it does not protect against all forms of malpractice, such as negligence.

Informed consent should be obtained for any procedure that is not "commonly done or easily understood." This phrase can describe almost any procedure performed in a dental office. Most dentists obtain a consent for treatment beyond a standard "prophy" and/or amalgam restoration.

How can the informed-consent process be incorporated into a treatment conference? Individual treatment recommendations are explained in detail to a patient during a treatment conference. This is the perfect opportunity to cover the proper parameters and obtain signatures on consent forms. Ideally, the forms themselves should be written in laymen`s terms and should be no more than one page in length for each procedure described. (Call about our Stepping Stones "Sample Consent Forms" booklet.) A copy should be kept in the patient`s chart and the patient should be given a copy to take home.

Recommended treatment cannot be influenced by insurance or managed- care restrictions. An insurance or managed-care plan that restricts benefits does not relieve the dentist from the obligation to advise patients of all necessary treatment recommendations. Informed patients may elect or decline treatment based on their benefits, but they must understand what the treatment entails and what the consequences may be. If a patient declines treatment, document it extensively in the patient`s progress notes.

Malpractice

The ADA estimates that 10 out of every 100 dentists will be sued in a given year. Many of these lawsuits will be related to lack of communication between the dental team and the patient, rather than due to actual treatment problems. Dental-treatment procedures may fail despite the dentist`s best efforts. When failures occur, patients may instigate litigation, particularly when inter-communication (including informed consent) has been lacking. In malpractice cases, a lack of informed consent can have a very negative impact on the dentist`s defense. Lack of informed consent can be considered no consent at all.

Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.

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