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The monster from 20,000 fathoms
For those who haven’t seen the 1953 film of the above title - and even I wasn’t old enough to see it on release - it is a horror film that is analogous of those fears that lurk under the surface of all of us. It is also symbolic of those things we forget most of the time, but raise their heads to haunt us at inconvenient moments.
There is a monster lurking behind us all the time in general practice and it has a name – Informed Consent!
In ‘the old days’ it was taken that if a patient opened their mouth for treatment then that was consent enough. We gradually took on the responsibility for ‘informed’ consent for treatment. This meant telling a patient:
- The cost
- The benefits
- The risks
- Whether you had the skills
- Whether it was available on the NHS
Although onerous, this was tempered by the legal test of “What would a body of reasonable and responsible practitioners have said?”
Dr Raj Rattan, senior dento-legal consultant at Dental Protection, told delegates at this year's Young Dentist Conference that failing to obtain patient consent before commencing treatment is one of the top risks for young dentists that can lead to litigation. Dr Rattan said: “It is vital that young dentists have an awareness of the factors that contribute to sub optimal care. By controlling these factors, new clinicians can help to provide the best care to their patients and prevent potential complaints and claims.”
Now the bar has been raised again.
Beware the un-said
A recent Supreme Court ruling, in the case Montgomery v Lanarkshire Health Board, has changed the criteria for informed patient consent in negligence law. Although the decision concerned a medical claim, the principle also applies to dental cases where there is a similar obligation to obtain consent for treatment. ‘The Supreme Court justified its decision on the basis of the change in the nature of the clinician/patient relationship.’
Dental professionals must now ensure patients are aware of all material risks and of all alternative treatments when obtaining consent. Rupert Hoppenbrouwers, Head of the DDU, says: “The new legal approach recognises that patients want to be well-informed about significant risks and reasonable alternative treatments.” This is not new to us though, because all this is already enshrined in the ethical guidance in the GDC’s (General Dental Council’s) Standards for the Dental Team.
A new way of thinking!
According to Mr Hoppenbrouwers, clinicians must now consider whether a person in the patient’s position would attach significance to the risk, or should reasonably be aware that the patient would be likely to attach significance to it. “Dental professionals will already be aware of the ethical need to warn patients about material risks but as a result of the judgement, making a detailed record of the information provided to the patient about the risks involved in proposed treatment is likely to be even more important.”
It is now more important than ever that we record everything we say to patients. A simple precis of the risks/benefits for each treatment should now be part of the clinical record.