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Ensure consent for ’high risk’ treatments

Dentists should not assume patient consent is implied before carrying out certain treatments, says UK-wide dental defence organisation MDDUS

MDDUS has dealt with a number of cases where dentists have proceeded with a course of treatment on the assumption the patient is in agreement, only to be subject to a complaint afterwards when the patient claims they had not in fact agreed.

According to MDDUS dental adviser Claire Renton, oral or implied consent is suitable for most treatments. However, for anything that involves higher risk, written consent might be necessary, especially if there is any doubt about the patient’s understanding of the procedure.

'When a patient sits in the dental chair and opens their mouth for a check-up, most practitioners would agree this demonstrates they are consenting to treatment,' says Mrs Renton.

'The patient may not explicitly say the words, but their actions suggest they are happy for you to proceed. This is implied consent or consent that is inferred from signs, actions, or facts, or by inaction or silence.

'Without it, and similarly oral consent, many dental practices would likely grind to a halt under the burden of securing formal written consent for each and every treatment.

'For anything that involves higher risk you might consider obtaining written consent to ensure that everyone involved understands what was explained and agreed. The most important step in any consenting process is to be satisfied that the patient has all the information they need and that they understand the implications of what is proposed.'

In Principles of patient consent, the GDC advises dentists that 'giving and getting consent is a process, not a one-off event that should be part of an ongoing discussion between you and the patient.'

'When circumstances change, for example, if agreed costs are likely to increase, then the patient must be asked to consent to any further treatment or extra costs,' adds Mrs Renton.

'It is important to be as clear as possible and not to assume that simply because the patient sits in the dental chair, for example, that you have free rein to carry out any treatment you believe is necessary.

'Obtaining consent is part of managing the patient’s expectations within a consultation. The crucial question is whether the person understands the procedure that is being proposed and can weigh up the relevant information surrounding it.'

Any question over a patient’s mental capacity further complicates the issue and there is more detailed advice available in the MDDUS Essential guide to consent

'Implied consent does not just apply to dental treatment but also when sharing information with other dental care professionals,' adds Mrs Renton. 'Contact your dental defence organisation if you require assistance or have any questions regarding consent.'

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