Dental Malpractice : Informed consent (Part1 )

  Informed consent is the approval of the patient, We hear it a lot in surgery or in operation more than in dentistry, but now informed consent is really a very important part of the dental practice that protect the dentist and it’s very important part to your patient. Your patient has the right to know the procedure and what is the complication that may happen.  

  So the term "informed consent" is a process by which the patient is apprised (informed) of the nature and risks of a proposed treatment, including no treatment or observation only, and then accepts a treatment plan (consents).

  What’s happening in our countries that we are proposing that procedure for the patient, not explaining what could happen after it and didn’t give him options of other treatment and this will make him so struggled and will lead to some sort of mistake but when you explain that to the patient and you get all these approval on a written consent we call it informed consent.

  Informed consent is required before a health care professional can validly defend against liability for battery or from responsibility for complications that may occur during treatment or observation.

Types of Patient Consent :

 1- Implied consent:
   Sometimes in dentistry they said that informed patient approval start when the patient opens his mouth (when the patient opens his mouth he is agree to do the procedure) and you can make it ok coz you can’t force the patient to open his mouth, but don’t rely on it very well.

  Provided the patient has the ability to give it, implied consent is given when the patient agrees to a treatment, or at least does not object, implied consent is a less reliable form of consent in a court of law there should be a malpractice suit.      

2- Written consent :
  Written consent is a preferred means of obtaining & documenting the patient’s consent & understanding of the procedure.

  Everything is written on papers and the patient understand what is going to happen to him and what is the procedure that he will have and he sign these papers.

  In dentistry, written informed consent usually is obtained for anesthesia involving sedation or general anesthesia, as it is for many other procedures.

  Some times in major surgery especially in dentistry in maxillofacial surgery (removal of tumor from a jaw or orthoprognathic surgery) which include general anesthesia.

  Children especially those that we can’t practice dental procedure on them on dental chair they should have general anesthesia so here for children we need to have informed consent.

  All cases where we have sedation or general anesthesia we should have informed consent.

Who did the informed consent? 
  Do you set in your disk and print it out from your computer and you give it to your assistant and your assistant gives it to your patient???…..
  NO THIS IS WRONG
Informed consent is your responsibility as a dentist…. you should take the consent and explain it very well every step to your patient and he should sign it in front of you. It is not the job of your assistant.

  Practitioners generally advise patients about both minor common complications and serious rare complications that can occur with the proposed procedures; in doing so, they cover both extremes of the spectrum of potential complications.

  For example : when I extract an impacted lower 8, this procedure for the removal of this impacted tooth have some sort of complication, one of these complication that you may hit the lingual nerve during the procedure and this may lead to anesthesia or numbness of the tongue or you may hit the ID nerve or you might have slightly swelling or slight elevation in temperature.

  So your job is to explain to your patient both extremities of the complication the patient should know that the procedure have some sort of complication (bleeding or swelling after the surgery).
And he should know that sometimes this procedure might have some sort of unpleasant taste in his tongue due to certain complication that might happen during surgery so it's your job to explain that to your patient.

  It's very wrong when you are doing such procedure that involve such surgical intervention to tell your patient that nothing will happen and everything will be fine and we are under control and you will have anesthesia and after one hour you will go and dance.
Never say these terms and never say we will have nothing this is wrong coz everything may happen.
You should protect yourself by this informed consent.

  For example : dr.haydar before 3 month has done an endoscope and he signed informed consent since he will take sedation anesthesia and his dr told him that he might hit the esophagus or might have injury to the stomach or might have bleeding as a complication. The dr doesn't want dr.haydar to run away but this is the right for correct choice of treatment which involves informing the patient about all complications.    

  But you don’t tell a patient for simple cavity that when I do filling for you, you may have pulp exposure. Pulp exposure is something that may happen most of the time due to negligence.
So in dentistry whenever you have general anesthesia procedure including surgical intervention it’s the right of the patient to know the complications from mild to major ones and to write it on the informed consent and sign it.


  What are the conditions that do not require an informed consent?????
Emergency cases.
Of course in hospitals in emergency cases it is not the patient who sign the informed consent but one of his relative.

Guidelines for Informed Consent :

• Use simple words & phrases.
To write it in an understandable way with simple word that the patient can understand it, not in English words but you should use simple words.

• avoiding technical terms, so that it may be easily understood
• Avoid overly broad statements such as “any and all treatment”
• When possible, should occur on a day separate from the treatment.
Its better to give the informed consent for your patient a day before the procedure, so he will have enough time to think about it and he will have time to consult other relatives (we have many members in our families and relatives they think that they understand much more than the dentist and when the patient told them that he wants to do surgical procedure they said no this will hurt you)but this is wrong, and this is the right of the patient to know coz some of our patient now  that they are so understandable and so educated they can go for the internet and search for that procedure and what might happen after it .