General dentists often perform many procedures on a tight schedule. This can inadvertently shift their priorities towards alleviating what feels like a disorganized day. When you’re pressed for time, noting whether a tooth has active decay or simply a stained but arrested cavitation may seem simple enough. But, in the context of documentation, it’s easy to forget just how crucial this information this can be in a court of law. In our rush to get into clinic, obtain a start check and finish a procedure in the allotted appointment time, many of us become guilty of failing to fully explain the contents of consent forms to patients. As a result, patients often do not fully understand what they’re signing for. Unfortunately, developing this bad habit early on in your dental career can have terrible consequences in private practice, especially when treatment complications arise that were not adequately explained to the patient from the very beginning.
So what exactly is informed consent? Based on the ADA Code of Ethics, informed consent reflects patient involvement and autonomy, under which “the dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions.” The American College of Dentists expands upon this principle by underscoring several important factors such as practitioner’s sufficient knowledge, truthfulness, unbiased presentation of all treatment options, clear communication on the part of the provider, and competency of the patient to make an educated choice.
The consequences of failing to obtain proper informed consent hit closer to home than you may think. According to the National Practitioner Data Bank, approximately one out of every twenty malpractice lawsuits reported in 2015 alone involved a dentist. These cases may involve postoperative infections from improperly sterilized equipment or poor technique, failure to diagnose and treat oral cancer or other dental conditions, and even permanent nerve damage from local anesthesia. In fact, a 2005 study in the Journal of the American Dental Association found that surveyed specialists obtained informed consent for the administration of local anesthesia twice as often than their general dentist counterparts. Serious complications from local anesthesia are very rare, but when you consider the fact that general dentists administer the vast majority of total local anesthetic injections given each year in the United States, taking the time to obtain that written informed consent just may be more helpful than you realize later down the line. After all, informed consent prior to the start of any procedure, when properly communicated and documented in patient records, can go a long way towards building patient-provider trust and preventing many lawsuits.
There are different approaches to obtaining informed consent, but based on my personal experience, simply presenting a patient with a page full of text has been the least effective. Even after taking the time to read through the page with the patient, there is always the risk that the patient might not fully understand the terminology used. Additionally, the patient may be overwhelmed by the amount of information presented to them and simply sign the paper without reading. Fortunately, providers have found creative ways to engage their patients and ensure their understanding. For example, oral surgeons sometimes provide short, educational videos that the patient can conveniently view while waiting for the procedure to begin. This helps to educate the patient on the possible risks and complications associated with a particular treatment so that the patient can go on to sign the consent forms without any concerns. Videos aren’t the only option – in the advent of new technology and media, the possibilities are endless. So get creative!
Dentistry is a career built on lifelong learning, so why not learn some good habits now? The next time you find yourself on the clock, take that extra five minutes to sit down with your patient and just talk to them. It’s a short-term investment towards a long fruitful career.
~Moh Yakubi, Arizona ’18