In addition to providing quality care, effective communication and good rapport should become a standard part of office management .objectives. Dentists can -be sued not only for negligent treatment but also for failing to
inform patients properly about the treatment to be rendered,
the reasonable alternatives, and the reasonable benefits, risks, and complications of each. In fact, in some states, treatment without a proper informed consent is considered battery. The concept of informed consent is that the patient has a right to consider known risks and complications inherent to treatment. This enables the patient to make a
knowledgeable, voluntary decision whether to proceed with recommended treatment or elect another option. If a patient is properly advised of inherent risks anda complication. occurs in the absence of negligence, the dentist is not legally liable. However, a dentist can be held liable when an inherent risk occ.urs after the dentist fails to obtain the patient’s infotmed consent. The rationale for liability is that the patient was denied the opportunity to refuse treatment after being properly advised of risks associated with the treatment and reasonable options. . Current concepts of informed consent are based as much on providing the patient the necessary information as on actually obtaining a consent or signature for a procedure. In addition to fulfilling the· legal obligations, obtaining the proper informed consent from patients benefits the clinician in several ways: First, well-informed patients who understartd the nature of the problem and have realistic expectations are less likel to sue. second, a’
properly presented and documented formed consent often prevents frivolous claims ‘based on misunderstanding or unrealistic expectations. Finally, obtaining an informed consent offers the dentist the opportunity to
develop better rapport with the patient by demonstrating a greater personal interest in the patient’s well being. The requirements of an informed consent vary from state to state. Initially, informed consent was to inform patients that bodily harm or death may result from ‘a procedure.
It did not require discussion of minor, unlikely complications that seldom occur and infrequently result in ill effects. However, some states have currently adopted the concept of “material risk,” which requires dentists
to discuss all aspects material to the patient’s decision to undergo treatment! even if it is not customary in the profession to provide such information. A risk is material when a reasonable person is likely to attach significance to it in assessing whether to have the proposed therapy.
In many states dentists have a duty to obtain the’ patient’s consent; they cannot delegate the entire responsibility, Although staff can present the consent form, the dentist should review treatment recommendations,
options, and the risk, and benefits of each option;the dentist ~ust also be available to answer questions. Although not required by the standard of care in many states, it is advisable to get the patient’s written consent
for invasive dental procedures. Parents or guardians must sign for minors. Legal guardians must sign for individuals with mental or similar incapacities. Incertain regions of the country, it is helpful to have consent
forms written in other languages or have multilingual staff members available. Informed consent consists of three phases: (1) discussion,(2) written consent, and (3) documentation in the patient’s chart. When obtaining informed consent, clinician should conduct a frank discussion and provide information about seven areas: (1) specific problem, (2) proposed treatment, (3) anticipated or common side effects, (4) possible complications and approximate frequency of occurrence, (5) anesthesia, (6) treatment alternatives, and (7) uncertainties about final outcome,
induding a statement that the treatment has no absolute guarantees.
This information must be presented so that the patient has no difficulty understanding it. A variety of video presentations are available describing dental and surgical procedures and the associated risks and benefits. These
can be used as part of the informed consent process but should not replace direct discussions between the dentist and patient. At the conclusion of the presentation, the patient should be given an opportunity to ask any additional questions. After these presentations or discussions, the patient
should sign a written informed consent. The written consent should summarize in easily understandable terms the items presented. Some states presume that if the information is not on the form, it was not discussed. It
should also be documented that the patient can read and speak English; if not, the presentation and written sent should be given in the patient’s language. To ensure that the patient understands each specific paragraph of
the consent form, the dentist should consider having the patient initial each, paragraph on the form. An example of an informed consent document
appears’ in Appendix V. At the conclusion of the discussion, the patient, dentist, and at least one witness should sign the informed consent document. In the case of a minor; both the ‘patient and the parent or legal
guardian should sign the informed consent. In some states, minors may sign the informed consent for their own treatment if they are married or pregnant. Before assuming this to be the ‘case, local regulations should be
.verified. . The third and final phase of the informed consent procedure
is to document in’ the patient’s chart that an informed consent was obtained after the dentist discussed treatment options, risks, and benefits. The dentist should record the fact that consent discussions took place
. and should also record other events, such as videos shown, ·brochures given, and so on. The written consent form should be included.
Three special situations exist in which an informed consent may deviate from these guidelines: ‘First, a patient may-specifically ask not to be informed of all aspects of the treatment and complications (this must be
specifically docmented in the chart). Second, it may be harmful in some cases to provide all of the appropriate int.ormation to the patient. This is
termed the therapeutic privilege for not obtaining a complete informed consent. It is somewhat controversial and would rarely apply, to routine oral surgical and dental procedures. Third, a complete informed consent may not be necessary in an emergency, when the need to proceed with treatment is so urgent that unnecessary delays to obtain an informed consent may result in further harm to the patient. This also applies to inanagment of Mplications during a surgical procedure. It is assumed that if failure to manage a condition immediately would result in further patient harm, then treatment should proceed without a specific informed consent.
Patients have the right to know if any risks are associated with their decision to reject certain forms of treatment. This informed refusal should be clearly documented in the chart, along with specific information informing . the patient of the risk and consequence of refusing treatment.
Patients who do not appear for needed treatment should be sent a letter warning of potential problems that may arise if they do not seek treatment. Copies of these letters should be kept in the patient’s chart.