At Tenbury Dental Centre we treat patients politely and with respect, recognising their dignity and rights as individuals. We also encourage patients to be involved in decisions about their care and, before embarking on any aspect of patient care, we seek their consent to do so – recognising the rights of patients to decide what happens to their bodies. We recognise that patients have the right to refuse advice or treatment and adhere to the Mental Capacity Act 2005.
We aim to provide each patient with sufficient information in a way that they can understand to allow them to make a decision about their care. We will use various communication tools to ensure that the patient understands what is being suggested.
In our discussions with patients, we explore what they want to know to help them make their decisions. We explain:
• why we feel the treatment is necessary
• the risks and benefits of the proposed treatment
• what might happen if the treatment is not carried out
• the alternative treatment options and their risks and benefits We encourage patients to ask questions and aim to provide honest and full answers. We always allow patients time to make their decisions (Cooling off period).Where changes to the treatment plan are needed, we obtain the patient’s agreement and consent before treatment, including to any changes in the costs. The patient is given an amended treatment plan and estimate.
Voluntary decision making
Decisions about their care must be made by the patient, and without pressure. We respect the patient’s right to:
• We always make sure that the patient understands whether they are being treated under the NHS or privately and what the costs will be. Where a patient embarks on a course of treatment, we provide a written treatment plan that is not full of jargon, making it easier to understand, which includes a cost estimate.
• Refuse to give consent to treatment
• Change their minds after they have given consent. Every person aged 16 or over has the right to make their own decisions and is assumed to be able to do so, unless they show otherwise. We recognise that, in some circumstances, children under 16 years may be able to give informed consent to examination and treatment, under if they are deemed to be competent (Gillick competency).
Where we have doubts about a patient’s ability to give informed consent, we will seek advice from our defence organization.
Ability to give consent
When this occurs we will not put pressure on the patient to reconsider but where we feel it is important, we will inform the patient of the consequence of not accepting treatment.
Decisions requiring patient consent
Examples of decisions that require patient consent are:
• Carrying out examinations and diagnostic tests, including soft tissue exams, perio charting, vitality testing, taking photographs, taking x-rays, etc.
• Administration of topical and injectable local anaesthetic prior to commencement of treatment procedures;
• Commencement of treatment procedures, including placement of fillings; preparation for crowns, bridges, veneers, inlays, onlays; root canal treatment; extractions; scaling and polishing, etc;
• Making referrals to other service providers; and
• Prescribing medicines; in particular the prescription of antibiotics.
Examples of decisions that do not require patient consent are:
• Observance of standard procedures that are essential to good practice: for example, cross infection control procedures (use of gloves, masks, eye protection, etc); and
• Matters of purely professional technique, such as selection of appropriate materials and instruments: for example, it would not be necessary to consult the patient over correct choice of elevators, endodontic files, cements and adhesives; HOWEVER, a patient should be consulted about issues that will affect outcomes in a manner that is obvious to them, such as shade selection for fixed and removable denture.
Written, verbal and implied consent
Written consent The guidelines issued by the Faculty of General Dental Practitioners recommend that written consent is obtained where a patient is to receive treatment under general anaesthetic or sedation, but not otherwise. We do not undertake these procedures within the practice and refer patients to other service providers where they become necessary. However, we do gain written consent from patients in the form of the NHS PR17 forms and treatment plan estimates. The PR forms are kept for 11 years and are stored securely in the practice whereas the treatment plan estimates are scanned in to the patient records and are then shredded.
Implied consent may be inferred from a patient’s actions. For example, a patient indicates consent merely by booking and attending an appointment and then by sitting in the dentist’s chair. However, we only rely on implied consent in limited circumstances.
• A patient may be considered to have consented to a dental examination because they booked the appointment, attended for it and sat themselves down in the chair. However, in practice the dentist always clarifies with the patient that they are going to have an examination before they lie the patient back and begin. It is important to note that while implied consent may be sufficient in the case of a dental examination, this implied consent cannot be taken to extend to attendant diagnostic tests, such as x-rays.
• Where a patient invites a spouse, parent, friend, carer, etc to join them in the surgery during an appointment, it may be implied that they consent to this other person being privy to what happens and what is discussed.
Verbal consent is by far the most usual form of consent to treatment that we encounter. Following explanations from the dentist or hygienist, a patient will usually communicate their decisions about treatment verbally. Where this occurs, we should make a record of it in the patient’s notes and back up any treatment decisions with a treatment plan estimate
Using Restraint – Having consulted the 2016 document by the British Society of Paediatric Dentistry, we decided under no circumstance do we feel it relevant to restrain children to have dental treatment carried out.
Reference: GDC Standards Guidance – Principles of Patient Consent
Next review March 2019