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Maintaining patient consent
Consent, respect and dignity are three vital aspects of the patient experience given high priority by regulating bodies and patients alike. The days when patients were prepared to be passive partners in their healthcare are long past. Nowadays patients will Google every aspect of their treatment plan and then challenge, or withdraw, previously given consent. This has created a new environment in which communication with patients needs to raise patients' dental IQs, and valid dental health education is central to gaining enlightened, informed and ongoing patient consent.
GDC Standards for the Dental Team, Standard 3: Obtain Valid Consent, offers detailed guidance on patient expectations and what dental teams are expected to do. This blog will look at Standard 3.1.5 which states:
“Patients can withdraw their consent at any time, refuse treatment or ask for it to be stopped after it has started. You must acknowledge their right to do so and follow their wishes.”
Consent needs to be renewed for each visit
The fact that a patient has consented to a procedure on one occasion, does not create an open-ended consent which can be extended to subsequent occasions. Consent must be obtained for specific procedures, on specific occasions. If consent is withdrawn it’s advisable to repeat the original consent process and reinforce previously given information about the:
- chances of success
- any alternatives to the procedure
The conversation with the patient needs to focus upon what the patient thinks will happen if they proceed with the treatment and the possible consequences of terminating the treatment. It’s vital to ensure that the patient has clear information which they understand and can evaluate to base their decision upon.
When considering what information to give the patient, base the conversation on:
- what a reasonable person would expect to be told about the proposed treatment
- the important and relevant facts, specific to the patient
- whether written information would be helpful to the patient; if so, make sure the information is sufficiently balanced – is it commercial marketing material produced by manufacturers and/or suppliers?
Make sure the patient understands the treatment and has been given an opportunity to discuss their concerns and have their questions answered.
Consider the extent to which the costs involved have influenced their decision. This includes any potential future costs in the event of possible complications.
Offer the patient the opportunity to obtain a second opinion.
When giving or withdrawing consent the same guiding principles apply. Consideration must be given to whether the decision is:
- Informed -the patient has enough information to make a decision
- Voluntary - the patient’s own decision
- Competent - the patient has the ability to make an informed decision
When a patient withdraws permission and these conditions have been met, the guidance says: “Treat patients politely and with respect, in recognition of their dignity and rights as individuals. Recognise and promote the patient’s responsibility for making decisions about their own body, make sure you do not take any steps without the patient’s permission. Explain the consequences of not continuing the treatment and ensure that they know that they are responsible for any future problems which arise as a result of not completing treatment. You must keep a detailed and contemporaneous record of this in the notes.
It is a general legal and ethical principle that you must get valid consent before starting treatment or physical investigation, or providing personal care, for a patient. This principle reflects the right of patients to decide what happens to their own bodies, and is an essential part of good practice. Patients have a right to choose whether or not to accept your advice or treatment.
Glenys Bridges – QCS Expert Dental Contributor