Informed Consent (quiz 1)

what are 2 aspects to informed consent introduced in class

1. legal issue

2. practice management issue - lawsuits/reputation

define informed consent as a legal issue

pt must be given sufficient info about the condition and recommended tx to allow a reasonable person to make a voluntary and informed decision

what are top 3 reasons a pt pursues a lawsuit (becomes litigious)

1. thinks you are overrating them

2. lingering pain and discomfort

3. feel improperly informed

what's the most important issue that will always be first priority to be treated first in dentistry

pain

its a good idea to ask a pt at the beginning of an appt if they've been having any pain anywhere in the body recently -- why?

common for them to report chest pain or other concerning symptoms -- can redirect tx plans for the day

legal/ethical issues: dentist has a professional and legal responsibility to inform the pt of their tx needs and options regardless of what?

give an example

regardless of perceived patient interest

- pt wants whitening, but have many caries --> whitening cannot be done until disease is under control (aka complete phase I tx)

can dentist's recommendations for tx be altered by insurance or perceived financial background of pt?

no- need to inform them of all options

if a pt travels from far to come to the dental school, can that alter the way you treat them (skipping protocol, speeding up tx, etc)?

No

real pt case: pt came to dental school with rampant decay, bone loss, teeth needing to be extracted. pt refused all extractions and wanted all teeth restored. pt threatened legal action and submitted quality assurance form to complaint about lack of tx. was the dental school wrong in not providing her tx?

no - do not provide tx that is not in best interest of the pt

what is the most common legal suit for malpractice brought against dentists

failure to diagnose

_____ dentists will be involved with a dental lawsuit in their careers

1/6 (maybe more)

should you offer guarantees on your dental tx (price, timeline, percent success of procedures, etc)?

no - not a good idea

in clinic, every time you make a tx plan, you are doing what also?

informed consent + documentation in PARTS note

on your fourth or later tx plan on a pt, CODA requires you do what

an informed consent competency on the pt

failure to reveal potential complications of dental tx has been ruled as ___ in some court cases

fraud

in axium, under "links", you can find what to help explain procedures to your patient

patient education manual (pictures, descriptions, etc)

t/f: written consent form can replace discussion with a patient

false - written consent form is a supplement to discussion

t/f: obtaining informed consent can be delegated to the receptionist

no.- needs to be done by qualified employee

if a dental hygienist is doing an SRP, are they allowed to obtain informed consent

yes they are a qualified employee

verbal consent without written documentation is legally sufficient or insufficient

insufficient

the only exception to verbal consent is what

if there is an emergency, but the dentist doesnt have the pt med consult back yet --> can call primary care physician and get verbal consent over the phone

legal competence is granted at what age

18+

and have not been declared incompetent through a legal hearing

if a pt is not legally competent, do you need to explain the tx to the patient

yes, and answer their questions

their POA signs the paper though

what is the only exception to informed consent

life threatening emergency

cases in which providers actions exceeded consent given or consent given without full information is considered:

battery

failure to obtain any consent is:

battery

define assault vs battery

assault - act which causes the victim to apprehend imminent physical harm (feel like they are going to be harmed)

battery - actual act causing physical harm

what are the 5 common elements of a lawsuit regarding informed consent

1. existence of the providers duty to inform the pt

2. failure to inform pt

3. evidence that, if informed, the pt would have chosen different tx

4. evidence that injury resulted from the tx rendered

5. a pt who filed a suit based on a providers failure to provide informed consent states a claim for assault and battery

even if tx received is adequate, can a pt still sue for lack of informed consent

yes

decision making should be ___ as part of informed consent

shared (bn dx and pt)

- pt has ownership in their tx plan (and their OH)

general consent (signed in axium) is valid for how long

1 year

does the general consent form in axium cover all informed consent for dental tx

no - its just for general consent for diagnostic data collection (to do basic screenings and exams, not tx plans)

what are 5 components to ULSD informed consent

- general consent form

- case presentation on tx plan (faculty verifies tx plan was properly presented to pt)

- signature on tx plan

- signature on chart-added planned tx (estimate button)

- tx notes

what is the code for the case presentation entry

D9450

at ULSD, pts sign that they understand tx plan fees will be honored for how long from the date the pt accepts the tx planned

24 months

what are the 2 ways to do a tx plan

chart adding

comprehensive tx plan

chart add is good for

minor changes to tx plan

note: some specialty clinics use ______ for a whole tx plan

Chart add (pediatrics)

before any tx can be initiated at ULSD, it must appear in ___ ___ under ___ ___ tab

planned treatments; treatment history

what are components to a tx note

- risks and benefits of proposed tx discussed with pt

- any complications that might be expected to occur (discussed with pt)

- all alternative txs present to pt and which option pt accepted

- risks and benefits of no tx discussed w pt

- pt accepted and signed tx plan

when tx plans change mid procedure, you should

sit patient upright, remove rubber dam if present, and talk to them