At Simpson and Nisbet Dental Centre we treat patients politely and with respect, recognising their dignity and rights as individuals. We involve patients 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.
Following the introduction of General Data Protection Regulations, patients now have more rights regarding the data we hold on them and how we process it. As before we must obtain consent prior to any treatment or sharing personal data with a third party (specialist or lab). Please see GDPR Policy.
We recognise that patients have the right to refuse advice or treatment.
Consent can only be obtained by someone who has sufficient information about the patient and the treatment options they are considering, including the risks, benefits and alternative options. In practice, this means that only the dentist or hygienist can obtain consent to treatment from a patient. This can be in both written and verbal but either way will be well documented.
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 use various communication tools to ensure that the patient understands what is being suggested. In particular, we:
- Show patients intra-oral photographs of their mouth and the teeth so that they can see what the dentist sees
- Show patients their x-rays and explain what we’ve found on them
- Use 3D models (study models) to explain disease processes and treatment options
- Ensure that we have up to date information and animations on our website to help patients understand their choices.
- Estimates so patients are also aware of the cost of the treatment options available
In our discussions with patients, we explore what they want to know to help them make their decisions and 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.
We always make sure that the patient understands they are being treated privately and what the costs will be. Where a patient embarks on a course of treatment, give them a written treatment plan and cost estimate; we provide one every time a patient requires further treatment. Where changes to the treatment plan are needed, we always obtain the patients agreement and consent, including any changes in costs too. We would print a new updated treatment plan and estimate for the patient to reassess and sign. The patient is then given an amended treatment plan and estimate and this is provided and signed by the patient. Denplan Care patients who will not incur a charge (other than their monthly fee or a lab bill) will also be given a treatment plan in the form of an estimate. This also states that when the lab bill is received that we cannot accept credit cards for this type of treatment but can happily accept cash, debit card or a cheque. We will also mention to Denplan Care patients the cost of the treatment if they were having the work carried out privately so they are aware of the savings they are making by being a Denplan Care member.
Decisions about their care/treatment must be made by the patient, and without pressure. Most people will feel able to reach decisions and give consent fairly quickly- usually at the same appointment where treatment is recommended. However, patients must always be given as much additional time as they need in order to reach a decision.
We respect the patient’s right to:
- Refuse to give consent to treatment
- Change their minds after they have given consent (consent is not ongoing and can be withdrawn at any time)
When this occurs we will not put pressure on the patient to reconsider but where we feel it’s important, we will inform the patient of the consequence of not accepting the treatment and explore with them any further alternatives that may be available.
Every person aged 12 and over has the right to make their own decisions and is assumed to be able to do so, unless they show otherwise. Children under 16 years may be able to give informed consent to examination and treatment, too. We always try to involve children in discussions about their treatment, even if they are not able to give fully informed consent on their own (refer to Child Protection Policy and Guidance). We ask patients over the age of 12 to sign a consent form allowing us as a practice to discuss treatment and appointments with parents or guardians. We often find it is the case that a parent will ring up on behalf of a patient to book an appointment to arrange this will siblings usually to work around school times. In these situations, consent must be obtained to carry out this action. This consent will be scanned on the patient’s records.
If a child is able to make decisions about their treatment and wishes to do so, we will respect their privacy and right of confidentiality- in other words, if a 15-year-old is competent (and wishes) to make decisions for themselves, we will respect their right to do so and will not share information about all their treatment with their parents without their permission (refer to Confidentiality Policy). This is the Gillick Test.
The ‘Gillick Test’ helps clinicians to identify children aged under 16 who have the legal capacity to consent to medical examination and treatment. They must be able to demonstrate sufficient maturity and intelligence to understand the nature and implications of the proposed treatment, including the risks and alternative courses of actions.
In 1983, a judgment in the High Court laid down criteria for establishing whether a child had the capacity to provide valid consent to treatment in specified circumstances, irrespective of their age. Two years later, these criteria were approved in the House of Lords and became widely acknowledged as the Gillick Test. The Gillick Test was named after a mother who had challenged health service guidance that would have allowed her daughters aged under 16 to receive confidential contraceptive advice without her knowledge.
In the case where a young patient gives consent to have treatment carried out which will incur a fee, we must give the patient an estimate. They will be told there is a fee attached. If the parent is going to pay for the treatment we would advise the patient inform the parent and ask that, with the patient’s consent, the parent would sign the estimate.
Where we have doubts about a patient’s ability to give informed consent, we will seek advice from our defence organisation.
Where someone other than the patient (e.g. the patient’s guardian) needs to be involved in a decision about their care (e.g. because the patient cannot give valid consent) we will identify them and ensure that they are involved.
Examples of decisions that require patient consent are:
- Carrying out examinations out diagnostic tests, including soft tissue exams, periodontal charting vitality testing, cold testing, taking photographs, taking x-rays, etc.
- Administration of topical and injectable local anaesthetic prior to the commencement of treatment procedures
- Commencement of treatment procedures, including; placement of fillings, preparation for crowns, bridges, veneers, inlays, onlays, root canal therapy, extractions, scaling and polishing, implants and sedation etc.
- Making referrals to other service providers
- 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.)
- 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 obvious to them, such as shade selection for fixed and removable prosthodontics.
Written consent: The guidelines issued by the Faculty of General Dental Practitioners recommended that written consent is obtained where a patient is to receive treatment under sedation, implants, Botox and Dermal Fillers and Whitening, but not otherwise. We do undertake these procedures within the practice and refer patients to other service providers where they become necessary. Accordingly, we do not normally ask patients to give written consent unless for the stated treatments. We may ask for written consent where there are unusual or exceptional circumstances.
Implied consent: This 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. For example;
- 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 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: This 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 always. In all cases consent must be accurate, adequate and not in any way excessive.
Reference: GDC Standards Guidance- Principles of Patient Consent
Last reviewed: May 2018