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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
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Soft Tissue Lasers
The modern dental practice continues to grow at a rapid pace. Many dental practices continue to work towards developing a “chartless” or “paperless” practice, where they can eliminate the physical patient chart and in some cases, most other paper-based systems in the office. Over the past 6-7 years, the technology that has been moving offices forward has been digital radiography, although the market penetration of this technology is till only around 25-30%. The next technology that seems poised for a major leap is lasers, and in particular, soft tissue lasers.
Give Them What They Want
The main focus of any practice is to provide our patients with the treatment and care that they obviously need. However, in 2007, many of our patients consider themselves to also be consumers. Meaning, it may not be enough to give them what they need, but also what they want at the same time. If you speak with any of the well-known practice management consultants like Sally McKenzie, they will all tell you the same thing: from a marketing standpoint, it’s far more effective to market to your existing patients than it is to try to bring in new patients. To accomplish this, we need to give the patients what they want. How do we know what that is? Easily…they’ve been telling us that for years. Patients want procedures that are “less”. Specifically, they want treatment that is painless, needle-less, drill-less, and bloodless. Thankfully, soft tissue lasers meet all of these criteria.
The Right Fit
s with any modern technology, it’s not necessarily the ideal product for every dentist out there. In working with offices all over North America, I’ve identified what I consider to be the four main types of candidates for soft tissue lasers:
- Dentists interested in patient comfort and conservative care. One of the catchphrases that have become popular lately is this concept of “minimally invasive dentistry”. Many dentists want to do as little damage as possible, remove as little tissue as they can, and make the procedure as comfortable as possible for their patients.
- Quality of treatment. Dentists are always looking for a better “mousetrap”, a way to do the old procedures more effectively than in the past. While there are many good selling points to the soft tissue lasers, one of the key ones is the fact that with a laser, the dentist can be more accurate, more precise, and have a more predictable outcome from the procedure.
- Efficiency. Many dental procedures involve a lot of wasted time. Imagine how much more efficient the office could be if they could immediately stop bleeding and have a dry field. This would cut down on the chair time needed and allow the practice to see more patients in the day.
- Finally, related to efficiency, would be the ability of the practice to become more profitable. Not only will they see increased efficiency, but they should more soft tissue procedures being done. This is because if the practice markets their use of the soft tissue laser properly, they will see an increase in the number of new patients coming into the practice.
So…What Do They Do?
Basically, any soft tissue procedure that a dentist can think of can most likely be done with a soft tissue laser. Some of the most commonly done procedures include: sulcular debridement, frenectomies, soft tissue crown lengthening, biopsies, fibroma removals, incision and drainage, second stage implant uncovering, removal of moles and hemangiomas, removal of hyperplastic tissue, uncovering of unerupted teeth for orthodontics, and treatment of herpetic lesions and aphthous ulcers. Some offices are even using soft tissue lasers during endodontic therapy for debridement of the canals. If you can think of a procedure that has been done in the past with a scalpel blade or electrosurgery unit, then you’ve thought of an excellent use for the soft tissue laser.
Soft Tissue lasers are slowly being recognized as a great addition to any office. Dentists who invest in soft tissue lasers will find that they can do their work more accurately and with a more predictable result. At the same time, they will attract new patients, keep their existing patients happy, and be able to provide a wider range of services to them. For the dental practitioner, the time to consider a soft tissue laser is now!
Lorne Lavine, DMD is the Founder and President of Dental Technology Consultants. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design and installation. Dental Technology Consultants provide dentists a full range of services relating to the implementation of technology.
Dr. Lavine can be reached directly at 1.866.204.3398.
Interested in speaking to Dr. Lavine about your technology concerns? Email him at Drlavine@thedentistsnetwork.net
Interested in having Dr. Lavine speak to your dental society or study club? Click Here.
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