Do We Need Consent Forms for Everything?

This quick article was inspired by a thread in a dental group (called “The Dental Place“) on Facebook.  Some dentists reported that they have a consent form signed for EVERY procedure they do.  For every patient, every time (even repeat procedures for the same patient).  Holy moly!  I rarely use consent forms, honestly.  But, that doesn’t mean I don’t use informed consent.

Informed Consent isn’t a form.

You know what will “protect” you FAR more effectively than a silly consent form?

A GOOD RELATIONSHIP.

And, it’s fairly easy.  Be nice.  Take the TIME to explain things (including potential risks vs benefits).  Don’t just mindlessly shove a consent form in their faces and have them learn, for the first time, about file breakage during endo… or a broken jaw from a wisdom tooth extraction.  That’s some scary shit without CONTEXT.

Informed Consent is a conversation.

If you insist on using signed consent forms, I would recommend having a CONVERSATION about potential risks FIRST.  The consent form’s list of “scary things” should be the SECOND time the patient hears of them.  That way they have some CONTEXT (they just heard from you) for the risks coldly listed by the emotionless piece of paper.

Sending your assistant in to hand the clipboard to the patient with a full page of solid text, “read this and sign here, please,” is almost confrontational.  The patient will likely comply, but it will be under duress, though you may not realize it.  And, did the patient REALLY understand what he or she read?  Did he or she even read it?  Your risk isn’t determined by the presence of the signature.  Your real risks are related to whether the patient is actually informed.

“Mary, as with everything in medicine and dentistry, there are risks with everything we do.  Most of them are quite remote in their probability.  And, in dentistry, most of those remote possibilities are fairly insignificant in the big picture.  Nevertheless, we are obligated to discuss them with you and answer any questions you might have.

For example, one of the complications with root canal treatment is a file can break off in the canal.  I’ve been at this for nearly 30 years, and it will happen to every dentist if he or she does enough of them.  In my 30 years of doing root canals, I’ve had exactly 3 files break.  And, in ALL of those three cases, it did not affect the positive outcome of the treatment.  In some cases, we can retrieve the fragment.  In other cases, the fragment becomes part of the root canal filling and the tooth is unaffected.  But, if it happens we are obligated to tell the patient.  Likewise, we are obligated to inform patients of that possibility, as remote as it is.

Other complications for root canals can include canals that we are unable to find or clean out completely.  Roots can have hairline fractures that go undetected until later.  And, sometimes a tooth simply doesn’t respond favorably to even the most perfectly performed root canal treatment.  Sometimes they just don’t work.  But, it’s an attempt to save a tooth that would otherwise need to be extracted.

Do you have any questions?”

THEN hand the patient the “form” to sign, if you must.

A signed consent form does NOTHING to protect you from a lawsuit.  It only documents that informed consent was obtained.  It’s not a “get out of jail free” card.  Without context and without a RELATIONSHIP, being told to “read and sign this” while a verbose legal-sounding form is shoved in their faces…. is intimidating and off-putting.  And, you may get away with it, if everything goes well.  But, what if the patient PERCEIVES something isn’t quite right (and didn’t expect it)?  Think a signed form will save the relationship, or save you from potential liability?

Be like Mike!

I’ve been at this for nearly 30 years (and I’m just getting started!).   I rarely use informed consent forms.  But, I DO TALK to the patient about risks vs benefits of treatment.  For endo (as an example), I talk about missed canals, broken files, perforations, cracked roots, failure even with a great clinical result, etc.  I do it in a conversational manner, and I document it in the chart entry.  So far, so good.

Informed consent is NOT a form.  Informed consent is a CONVERSATION (which leads to a good relationship).  It’s about managing expectations.  Again, you can use a form, if it makes you happy.  But, please have the conversation first.  And, document that you had the conversation, even if you also use a signed form.  People don’t sue people they like.  Be likable!  🙂  But, also trust your instincts.  If your spidey senses are on alert, consider referral or terminating the relationship.