1) Why do we need consent?
For legal reasons (converts unlawful touching into lawful practice), moral reasons (respect a patients right to self determination) and clinical reasons (makes it easier to treat patient with better outcomes).
2) What does the GDC Standards say about consent?
The GDC’s standards state that you must obtain valid consent before starting treatment, explaining all relevant options and costs. It is important not to assume that someone else has obtained the patient’s consent – this may be particularly relevant when considering referrals within the practice.
3) Is it a one-off?
Consent (and refusal) is not a one-off issue – this can change over time so you need to confirm consent prior to any treatment.
4) When is consent valid?
No other person can consent to treatment on behalf of an adult and to be valid, consent must be without coercion from operator or third parties. Coercion may be attempted by using emotionally charged words e.g. if trying to convince the patient not to have a root canal phrases like ‘drill deep into the tooth’ and ‘remove the nerve’ may be used. Be aware of the effect of language on patients.
5) Who can give consent?
6) How much information do I need to give?
There are usually a number of treatment options available for a particular clinical scenario. The patient must have sufficient information upon which to make a decision. When discussing risks, the dentist should be reasonably aware of what that particular patient would attach significance to (Montgomery rules) – just because there is a low percentage for a risk it doesn’t mean you don’t tell the patient. You have to judge if that patient will attach significance to it – so clearly it’s important to get to know your patient as more than just a mouth!
7) What do I do if my patients don’t remember what I tell them?
Studies show that 40-80% of medical information is forgotten immediately and the greater the amount presented, the lower the amount recalled. It’s helpful to provide written text backing up relevant information that you have discussed. It’s also useful to ask patients to repeat back what they can recall so you can make any clarifications.
8) When do I need a signed FP17DC form and when do I need written consent?
You need a signed FP17DC form for band 2 treatment, band 3 treatment, band 1 if the patient requests it or if carrying out a mix of NHS and private work. Legally, you only need written consent for GA and sedation. But for risk management purposes, it is also recommended for high impact procedures e.g. wisdom teeth and elective procedures e.g. orthodontics, cosmetic dentistry and implants. A signature alone is not consent but it does show you’ve gone through a process. It’s the process itself which protects you and the patient. Similarly, consent forms are a good idea but not a substitute for good communication.
9) Am I allowed to record my conversation with a patient?
Yes, with the patient’s permission. If you do this, it should be with the aim of delivering the best possible care to the patient rather than working defensively. It may be useful for complicated treatment plans. However, you will need to consider retrieval and data protection issues.
10) What do I do if my patient doesn’t speak English?
The consent process can be difficult if the patient doesn’t speak English. Try to request professional interpreters rather than friends or relatives.