.
are not obliged to treat all patients
There will be instances where, already at the first treatment plan discussion (initial diagnostic phase), we realize that we are not in a position to treat a given patient in a manner that is agreeable to us. In these cases, we may feel that, for a number of reasons, it is better not to start any treatment at all. Some of these reasons may be immediately evident, but unfortunately others may not. Obviously, it is always our duty to try to help, but if the situation does not feel right, or we are in serious doubt about whether we should commit to treating a particular patient for whatever reason, we need to heed that warning voice. If we conclude that we will not be able to help a patient properly, we have the right and the duty to suggest without prejudice from the outset – as kindly as possible and with the appropriate humility and politeness – that there may be more capable professionals who will be better able to help. It is therefore much better to spend more time initially with new patients, speaking clearly to them and carefully analyzing them and their situation.
Prosthodontics is often a matter of invasive and extremely complex treatments that go on for a long time, treatments that may dramatically change the esthetics and functionality of a patient’s mouth, teeth, and face. Therefore, we need to be sure that we will be able to work with the patient’s full compliance and understanding about the often difficult challenges that may lie ahead in the course of the treatment.15 The longer the treatment, the greater the need for clinician–patient understanding and trust. If during the first visit or during the treatment plan discussion we cannot communicate properly, or if patients are unable or unwilling to communicate properly with us, this may indicate the possibility that we will end up working under great stress or tension, with the possibility of misunderstandings. This, in turn, could result in the failure of the treatment, with further deep frustration as well as possible legal problems and consequences.16
If an emergency occurs and our diagnosis is clear and precise, we have a duty to explain to the patient what the emergency is, how and why it should be addressed, and what the costs of the procedure will be. In that case, always ask for written permission to treat the patient and request the patient’s full compliance and signed agreement before you proceed with the treatment. This applies even in a situation where we know the patient well. It is important to understand that even in the case of an emergency we require a patient’s full compliance via an informed consent document, if possible signed by themselves or, if not possible, by another responsible adult such as a parent or guardian.
The use of the informed consent
The informed consent document needs to be very accurate and even customized in some cases. 6,27,41-50 There are various examples of informed consent forms and formats to be found on the internet. However, as every patient is an individual whose data will differ from the next patient, you will find in later chapters many suggestions about what to remember to include in the informed consent document. Please bear in mind that these suggestions are made from the vantage point of many years of experience.
Another thing to bear in mind is that dentistry and prosthodontics do not deal with an immediate threat to life. Therefore, patients can take all the time they need to listen to our proposals for solutions to their problems. They can then ask all the necessary questions in order to understand exactly what we are suggesting. They will then hopefully agree to a treatment plan and sign the informed consent form that we submit to them.17,30,34,51-55,57
Essential aspects of the informed consent document
All informed consent documents pertaining to a specific treatment plan should contain at least the following elements:
1. The patient is fully informed about all the characteristics of the entire treatment.24,29,30,42,45,47,58-61
2. The patient has a full understanding of the treatment plan in terms of its diagnosis, prognosis, anticipated benefits, therapy, timing, certainties, risks, consequences, and the need for future controls.17,30,34,51-53,56,57,59-61
3. The patient has been informed of alternative treatment courses and associated risks.42,62
4. The patient is fully aware of the risks associated with refusing the recommended procedures.17,30,34,51-56,59-61
5. The patient is fully aware of any possible temporary incapacitation that may occur during the course of treatment.17,30,34,51-56,59
6. The patient is fully aware of what information the patient is rewriting in front of witnesses (see later), freely accepts the treatment plan, and fully intends to be treated by the clinician in full respect of the professional rules of the dental office.