Informed Consent: A trap for the unwary

Sept. 1, 2009
My receptionist called my private office to announce, “Doctor, there's a letter at the front desk you have to sign for.

by Duane A. Schmidt, DDS

For more on this topic, go to and search using the following key words: informed consent, risk management, audio–visual informed consent videos, patient satisfaction, adverse results, Dr. Duane A. Schmidt.

My receptionist called my private office to announce, “Doctor, there's a letter at the front desk you have to sign for.” I signed and wondered who could be sending me such a special letter.

“Dear Doctor: We represent your patient, Amanda Jones, in what we believe to be your delivery of dental services below the standard of care. We demand that you send all of her X–rays, records, and supporting documents in reference to Ms. Jones' treatment by return mail to …”

I recalled Amanda's difficult extraction and shuddered. It seemed that everything that could go wrong had, and it ended with a dry socket.

I took stock of the X–rays, and they were perfect. The ledger notes met the standard of care, including records of pre–op precautions. Blood pressure, temperature, and questions about changes in her health history were all fulfilled.

All our ducks seemed to be in a row, except for one small detail: the informed consent. A long–time staffer had walked Amanda through a litany of possible adverse results. She had been told that everything that occurred to her was a possibility, and she had signed the form stating that she understood these risks. But now a lawsuit?

Every day, this same scenario plays out in dozens of dental offices. By the end of the month, several hundred dentists have had their days shattered. By the end of the year, thousands are shattered. Why?

Risk management specialists claim that patients who have unrealized expectations are the genesis of these legal fishing expeditions. In brief, patients expect heavenly experiences, but dentists, being mere mortals, can only deliver earthly results. As with all rewards in life, there are risks, and explaining those risks is what an informed consent is all about.

Unfortunately, the methods we use to deliver data to obtain those consents may be flawed. When the perils of the procedure — a crown, a root canal, a denture, or a surgical procedure — are explained to patients verbally, due to the exigencies of the moment, people tend to forget they were told a hematoma might occur, a root canal file may go astray, or a first–time denture may need a liner. Often, when the unexpected happens, if patients do not receive satisfaction from their dentist, the easiest route is to visit their attorney for “the letter.”

The other method of delivering an informed consent is to hand the patient a slip of paper that tells him or her of possible untoward results. The problems with each method only truly occur in the courtroom. If worse comes to worst, and the dentist refuses to pay any demanded legal ransom, a jury trial may occur, and here the argument simplifies.

The patient says, “I wasn't told about things that could go wrong” or, “I didn't get enough time to read the document” or, “I didn't understand the wording.” Any way is a losing situation because juries are prone to sympathize with a sad story.

The quickest way out of this conundrum is for the dentist's insurer to throw a few thousand dollars at the problem. The attorney pockets a commission and the patient receives recompense. This can be simple, unless you are the dentist who now has a black mark on your insurance record.

In the 1980s, when we realized these events were occurring in our growing practice, we opted for the audio–visual teaching format and scripted informed consent videos that told the flip side of four procedures — crown and bridge, dentures, root canals, and surgery.The illustrated videos, which are narrated in simple English and delivered in three to four minutes, give patients true information. Suddenly, our patients experience a new level of understanding.

Risk management experts claim that 80% of our patients have unrealized expectations in our dental offices. But, in two decades of use, these audio–visual informed consent videos have prepared our patients to expect realistic results following dental procedures. As a consequence, the satisfaction level of existing patients has risen to new heights — and the proof is in the continuous flow of new patients and the return of existing patients.

Audio–visual informed consent videos may be viewed at, where free office documents may also be downloaded.

Dr. Duane Schmidt is a Fellow in the American Academy of Pediatric Dentistry, an adjunct professor at the University of Iowa College of Dentistry, and a published author. With a staff of 55, he led the creation of a 34–chair dental practice in Cedar Rapids, Iowa. Reach him at [email protected].

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