It is a general legal and ethical principle that as dental professionals we must gain valid consent, explaining all the relevant options and possible costs before starting treatment or physical investigation on our patients.
This principle gives patients the right to decide what happens to their own bodies, and is an essential part of good practice. The patient has the right to accept or decline the advice or treatment and this should always be documented on the patient’s notes, as well as being noted and signed on a consent form and/or treatment plan.
The GDC Standards document (p.30) states:
You must make sure you have valid consent before starting any treatment or investigation. This applies whether you are the first member of your team to see the patient or whether you are involved after other team members have already seen them. Do not assume that someone else has obtained the patient’s consent.
This shows that consent is an important and compulsory requirement, and failure to obtain it may lead to serious consequences such as a fitness-to-practice hearing.
Consent itself is more than just a signature – it is an understanding and agreement between the dentist and the patient. Whilst a signature is evidence of consent, it is the discussions that take place with the patient that determine whether the consent is valid. It is important that the patient is aware of everything they need to know and everything they want to know, as suggested by the GDC Standards, including:
- options for treatment, the risks and the potential benefits;
- why you think a particular treatment is necessary and appropriate for them;
- the consequences, risks and benefits of the treatment you propose;
- the likely prognosis;
- your recommended option;
- the cost of the proposed treatment;
- what might happen if the proposed treatment is not carried out;
- whether the treatment is guaranteed, how long it is guaranteed for and any exclusions that apply.
A detailed consent form alongside a treatment plan should outline all of the above details and can be elaborated on with a discussion. You must check that the patient has understood everything you have discussed before the patient consents with a signature.
It is important that our patients do not feel pressured into going ahead with the proposed treatment. We are there to inform them of any problems they may have and to offer a solution. We can help patients understand the theory behind their options by introducing them to treatment coordinators who can explain all of their options in more detail, provide information leaflets, use diagrams and pictures and give them time to reflect on their options before we carry out the treatment.
There may be a situation where the patient needing treatment is unable to communicate themselves. It is important that we encourage our patients with communication difficulties to have a friend, relative or carer present to help them ask questions. This can be a complex area, so please ensure you refer to appropriate legislation if necessary. There are a number of ways that our patients can show their consent (or decline to give it, or withdraw it) during treatment, such as through their body language. If you can see your patient pulling away or trying to remove your dental equipment from their mouth, this indicates that they are withdrawing their consent for you to carry on until they are ready for you to do so. A good investment for dental practices is a clicker. This is a small hand-held device with a button that makes a loud clicking noise when pressed. This enables patients with communication difficulties to indicate to the dentist – without needing to move too much – that they want treatment to stop until they are ready for it to continue.
After consent has been obtained (whether verbally or in writing), the patient has the right to withdraw at any point - including after the treatment has been started. It is crucial that the patient’s wishes are acknowledged and the treatment is stopped immediately. As a professional you must explain to the patient the risks and consequences of not continuing with the proposed treatment, and inform them of problems that may arise in the future as a result. Everything discussed must then be recorded in the patient’s notes, and for certain treatments a treatment refusal form may be signed and linked to the patient’s records. Another situation that may arise is if the required treatment changes after consent has been obtained. For example, if a root canal treatment is unsuccessful, the patient will therefore no longer need a crown to support the tooth structure and instead will need an extraction and possibly a replacement option. It is crucial that we explain everything to the patient, explain to them their options, and let them make a decision. This must be documented and another up-to-date treatment plan and consent form must be signed.
In conclusion, it is crucial that all dental professionals are aware of the importance of and reasons behind gaining patient consent. Our patients are not obliged to go ahead with any treatment options we provide. They should be made aware of everything available to them, and they can withdraw from treatment at any point. Many disciplinary hearings take place because of dentists who have not obtained proper consent. It is a form of abuse to treat a patient without their authorization, and it can have multiple consequences for all concerned, including loss of registration for the dentist. Everybody that is registered with the General Dental Council is provided with the GDC Standards booklet, which is also available online. Section Three provides us with information regarding consent.
Although obtaining consent may seem time-consuming, it may well save substantial distress for the patient, not to mention hours in the courtroom and thousands in legal fees should some mishap occur.
References
General Dental Council. Standards for the Dental Team. (2013).
