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Issue #17 - 4.10.07
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When Do You Need Consent?
According to the May 11, 2006 issue of the New England Journal of Medicine, nearly 40% of all medical lawsuits are groundless. Yet millions upon millions of dollars are spent each year defending physicians against such suits. That doesn’t begin to account for the physical and emotional toll that is taken on the doctor, the family, and the practice.
Admittedly, dentists face fewer malpractice claims than their physician counterparts, but in this litigious society taking a few fundamental risk management steps - starting with detailed, well-organized patient records - to protect your practice and your reputation can pay huge dividends should you have to defend the care you’ve provided.
Carol Tekavec, CDA, RDH, is President of Stepping Stones to Success, a company that specializes in patient records and other practice documents. She encourages dentists to implement an informed consent process in their practices, the key word being process. Ms. Tekavec notes that the parameters of informed consent have evolved over many years and the current thinking is that it is not merely a form, but rather a progression of steps.
The process involves nine factors: 1. Recommended treatment. 2. Risks of treatment. 3. Alternatives to the recommended treatment. 4. Risks associated with the alternatives treatment. 5. Consequences of doing nothing. 6. Fees associated with treatment. 7. Documentation that patient questions have been answered. 8. Confirmation that no guarantees have been offered. 9. Information provided in written format.
Although it isn’t wrong to address the nine factors in the progress notes, Ms. Tekavec recommends separate forms. “With a separate form, the doctor is able to focus on the details of the specific procedure he or she is recommending. The patient signs it, dates it, and copies are retained in the record and given to the patient. Should there be a problem in the future, the onus is on the patient to explain why they didn’t understand.”
Ms. Tekavec acknowledges the documentation is not a guarantee of protection against dental malpractice suits; however, it can be critical in defending the doctors actions. Moreover, in the event that the procedure results in a poor outcome – not malpractice – the informed consent process can demonstrate that the possibility of a poor outcome was discussed with the patient prior to the patient agreeing to proceed with the recommended treatment.
So which procedures require informed consent? That, notes Ms. Tekavec, is subject to interpretation. “I’ve asked numerous attorneys exactly what types of treatments should dentists should be getting informed consent on. They recommend those treatments that are not commonly done or easily understood, but that could be interpreted to be virtually any procedure performed.”
For that reason, Ms.Tekavec developed a comprehensive informed consent booklet that addresses several different procedures and scenarios, including: general consent to treatment, permission to treat a minor, endodontics treatment, amalgam fillings, implants, home whitening, and several more.
Her forms state the specific diagnosis, explain the recommended treatment as well as what the patient may notice with that treatment over time. For example, her document, “Informed Consent of Tooth Colored ‘Fillings’” explains that the “materials can fade, darken, or stain over time. … Newer materials make these changes less likely.”
The text goes on to explain the potential problems associated with tooth colored restorations, such as sensitivity, post-operative pain, etc. It states that the patient understands the treatment options, risks associated with the options, consequences of doing nothing, and the cost of treatment.
She acknowledges that some dentists are reticent to follow such a process. They perceive it as being time consuming and, in some cases, they are concerned that they will scare the patients into declining care. However, more and more dentists are using some type of form. And Ms. Tekavec encourages practices that develop their own forms to keep the document simple and straightforward and avoid a “one-form-fits-all” approach. “I’ve seen practices using forms that don’t address a specific treatment, and they are five pages long. That’s too much for the patient.”
The point is to ensure that the patient is informed on all aspects of the procedure. While certain outcomes are less likely, being aware of the potential for a negative outcome, no matter how remote, is critical to providing all of the facts necessary so that the patient can consent to or decline treatment based on clear and factual information.
Sally McKenzie is CEO of The McKenzie Company, Inc. a nationwide dental management, practice development and educational consulting firm. Working “on-site” with dentists since 1980, McKenzie Management provides knowledge, guidance and personalized systems that have propelled thousands of general and specialty practices to realize their potential. Sally can be reached directly at 1.877.777.6151
Interested in speaking to Sally McKenzie about your management concerns? Email her at Sally@thedentistsnetwork.net