Valid consent to dental treatment
Many claims surround the issue of consent to dental treatment and all dentists are under a legal obligation to obtain valid consent before any treatment is carried out.
The General Dental Council has 9 principles that they expect dentists to follow. Principle 3 covers consent to dental treatment.
Principle 3 of the GDC Standards in a nutshell
Dentists must make sure that they have valid consent before starting any treatment or investigation. This applies whether you have seen the dentist before or not. The dentist should not assume that another member of the team has already obtained your consent to treatment.
Any discussions as regards treatment options should be recorded in your dental notes. Although a signature on a dental form is important in the dentist verifying that you have given consent, it is the discussions that take place with you that determine whether consent is valid or not.
The dentist should find out what you want to know and also tell you what you might need to know. This includes such things as:
- Options for your dental treatment;
- Why the dentist thinks one option is better than another for you;
- The consequences , risks and benefits of the treatment proposed;
- The likely prognosis for the treatment;
- 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;
Dentists must also check that you haver understood the information that has been given to you.
Remember, as a dental patient, you can withdraw your consent at any time. You may refuse treatment or ask for it to be stopped even if it has started. The Dentist must always respect these rights.
If your dental treatment consists of sedation, then written consent must be obtained.
As a dental patient, your dentist must give you sufficient information along with a reasonable amount of time to consider the information and make a decision. Arguably the more complicated the procedure, the more time you should have to make a decision.
Dentists must tailor the way that consent is asked for depending upon your needs. Information must be given in a way that is easy for you to understand.
If you have trouble communicating, it is encouraged that you have a friend or relative with you who can ask questions about anything you are worried about. The dentist must always consider whether you are able to make a proper decision about your care and should avoid making assumptions about your ability to give valid consent to treatment. Dentists should check and document in your clinical records that you have understood the information that you have been given.
Consent to dental treatment is not a one off event and it should be part of the ongoing communication between you and the dental team. You should never be kept in the dark about the progress of your care and your dentist must ensure that they have specific consent for what is going to happen at each appointment.
If your treatment changes or the cost is altered, your dentist must obtain your consent to the changes and record that you have done so, before any treatment is carried out.
The GDC gives the following example on their website as guidance on failing to obtain valid consent to treatment:
Mrs Wilson went to see her dentist, Mr Harris, as she had a chip at the bottom of one of her front teeth and she wanted it filled.
Mr Harris said that he could provide a white filling on a private basis at a cost of £80 and asked whether Mrs Wilson would like it done immediately. Mrs Wilson agreed and so Mr Harris carried out the treatment.
When Mrs Wilson went to reception to pay, she was charged £120. When she questioned the amount, she was told that was the price that had been written in her notes. Mrs Wilson thought she may have misheard Mr Harris and so she paid the £120.
Two days later, whilst eating her lunch, the filling fell out. She went back to see Mr Harris and asked for the filling to be redone. He said he could redo the filling but it would cost her another £120. He said that he warned her when he did the filling that it may not last for very long. Mrs Wilson questioned why she had been asked to pay £120 for the first filling rather than £80 and why she should pay again after only two days. Mr Harris said it was clear from her notes that he had told her the filling would cost £120. Mrs Wilson then left the practice.
She decided to write a letter of complaint to the GDC. In her letter she said that Mr Harris had misinformed her about the cost of her treatment and that at no point during the initial appointment did Mr Harris tell her that the filling was unlikely to stay in place for long, nor did he offer any advice on how to prevent the filling from falling out.
The fitness to practise caseworker considered that Mr Harris may have breached a number of the standards and guidance in Standards for the Dental Team including (but not limited to):
- 3.1 You must obtain valid consent before starting treatment, explaining all the relevant options and the possible costs.
- 3.1.3 You should find out what your patients want to know as well as what you think they need to know. Things that patients might want to know include:
- 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 carried out; and
- whether the treatment is guaranteed, how long it is guaranteed for and any exclusions that apply.
The case was referred to the Investigating Committee. The committee thought there had been a failure in communication. It also thought Mr Harris may not have obtained Mrs Wilson’s consent as the costs were not clearly explained to her, nor was she advised of the risks associated with the filling. The committee decided to issue Mr Harris with a letter of advice reminding him of the importance of providing patients with clear information on costs and risks associated with treatment.
Learning Points
Although Mr Harris made a note of the treatment cost in Mrs Wilson’s records she maintained that she did not know the treatment would cost £120. If Mr Harris had provided Mrs Wilson with a written treatment plan, then it would have been clear to her how much the treatment was going to cost. The dentist must discuss treatment options and costs with patients before formalising your discussions in a written treatment plan. The dentist should also include as much information in your notes about those discussions as possible.