I’ve been involved now with postgraduate education for 12+ years now, teaching orthodontics and cosmetic dentistry. Often, we would be teaching these topics to dentists who, to date, would have a very limited understanding of those subjects. There’s quite a big jump for dentists to go from general practice into these more specialist type areas, especially when it comes to orthodontics and cosmetic dentistry. So that leap in itself is quite scary, but what a lot of dentists really got put off with was the documentation around those procedures.
One of the big things was always consent. It was a perennial problem that kept coming up, raising its head over and over again, the question of “how do I give good consent?” In 2014/2015, it all changed in the dental medical profession as to how consent needed to be obtained.
Previously when we gave consent to a patient, as long as we gave it in terms of what we thought the patient could understand, it was sort of accepted. But after 2014, there was a landmark case which changed things for medicine and dentistry and the onus was very much on the doctor or dentist to make sure that the patient understood all the risks and benefits of treatment, as well as the pros and cons of not having any treatment. It was up to the medical professional to make sure that the patient really understood the risks in order for them to give valid consent.
So that shift emphasis really changed the way that consent had to be given and what it required. It required the professional to engage more fully with patients. The problem then was that quite often when procedures were carried out, consent often failed. When there was a complaint, quite often patients would come back and say, “Well I didn’t really understand the procedure.”
Medical professionals were caught in this loop of saying that they explained it as best as they could, but irrespective of how well you explain something, there’s no guarantee that the patient has understood something. A lot of patients genuinely, not just disingenuous, but genuinely said, “Well actually, you know, I was given the form to sign at the last minute, I sort of felt a little pressure to sign it, I didn’t really have the time to understand the pros and cons of treatment and had I known that, I may have changed the way that I would have engaged with treatment.” So, at that time, we looked at the various ways that consent was being given and basically across the board, it was very poor.
It was, very often, a paper form. Lots of written words, two or three pages, which was sometimes very difficult for a patient to digest, certainly in a limited time frame, just as the patient was going to have this treatment. Even to this day you still see patients just signing something. I’m sure you’ve been in that position where, you know, you haven’t really had the time to digest the information and then to weigh up the pros and cons of treatment before deciding to proceed.
So this is the problem that we want to address and we look at all the protocols for a consent out there, we just realised there was nothing that really ticked all the boxes.
If you go to the GDC website, the GDC has its standards of care and consent. They have a list of the requirements for consent, for it to be valid. Those things include making sure you give patients a full understanding of what the treatment is; the pros and cons of treatment, as well as the pros and cons of not having treatment – and you must give them enough time to make a valid decision. You must also make sure that they understand what you’ve put in front of them. It’s that understanding bit that was always very difficult. This really, in later years, gave rise to this ‘no win, no fee’ claim. It was always easy for the lawyers if there were some spurious claims, to say to a patient, “Well did you really understand the consent?”
iConsentu: taking the lead from the GDC for better consent
Nothing really ticked all the boxes in terms of what the GDC wanted. So we started with a blank sheet of paper and basically used the GDC framework as our guide and said, we need to make sure that we have a consent procedure that really ticks all of those boxes.
Consent is not a one-point thing, it’s a continuous process. So as treatment continues and things change, obviously patients’ consent needs to be re-addressed. Having a system that the patient can engage with, really is a big, big tick box in making sure that you have gained proper consent. So that’s the process that we have developed.
We looked at all the different procedures within dentistry, and worked with lawyers in professional indemnity. We asked the question, for any given treatment, “Where are the most common areas of complaint or litigation?” For any given procedure, there’s always a half a dozen, you know, maybe six-to-eight things that just keep coming over and over again. So, what we did for each procedure was we developed a short animation, usually about three minutes long, which covered all those aspects of treatment where patients were likely to be confused or didn’t understand, and we try to make it as simple as possible for them to understand.
That was the first bit, and the next bit was again to make sure that the patients understood what they had just seen. We created a very short, multiple-choice, question-and-answer session where we could test their understanding of the procedure. If, at any stage during that process of answering those multiple choice questions, they didn’t understand the question, the process would take them back to just that section of the video which they can then listen to again. At that point they can clarify their understanding and then, you know, choose the right answer. They then take a photo of themselves and sign the full consent form. Now, this whole process is emailed to the patient so it can be done at home. That then ticks the box of giving patients enough time to go over the material and to come to a decision as to whether to proceed with treatment or not.
So, that was another big tick, because again, even to this day, most commonly consent is done five minutes before the treatment.
Once the consent procedure is completed, all the information is emailed back to the dentist and when the patient then does arrive for the treatment, the dentist can review the consent, they can see the questions have been answered correctly and if there’s any areas where the questions haven’t been answered correctly, then this is another opportunity for the dentist to go over that bit with the patient and make a note that they’ve done that.
The patient also has an area, when they’re completing the consent, to ask any additional questions. So any additional questions that the patient has asked while they were doing the consent, the dentist has the opportunity to cover that as well.
The patient then does a quick final sign off to say they’re happy to proceed with treatment and then all the documents are emailed to the patient and to the practice and stored safely with us.
Additional Benefits for your Dental Practice
There are quite a few additional benefits for the practice. One I’ve already alluded to is that it does save the practice time. The last thing a busy practice needs is for a patient to spend a lot of time prior to treatment reading and signing consent form, which then impacts the treatment time. Often the patient will arrive late for treatment, then they have to do the consent, or quite often, the consent is just left because there’s just no time. So saving time is really important. Making sure that the practices are compliant. It’s a big thing, especially nowadays with CQC making sure that the practice is actually compliant with consent.
Having industry standard consent forms is always one thing that a lot of dentists have asked us over the years. “I do this procedure. Do you have a consent form for that procedure?” All of the procedures come with pre-loaded, industry-standard consent forms and we’ve spoken to key opinion leaders in each of those fields to make sure that the consent form does meet that standard.
Dentists should be confident in the consent that they’re giving to the patient, that the written part of the consent is up to date and of an industry standard. However, should they wish, they also have the option to replace that consent form with their own consent form. Some dentists who are maybe specialising in certain areas would have specific consent forms that they like to use. Our consents are also continually updated, so dentists can be really sure that they’re continually getting the most up to date consent form.
How iConsentu has a positive effect on premiums
I think one of the big challenges insurance companies have had over the years, when a claim does arise, is doctors and dentists are notoriously poor for record-keeping! Even with the ones that are good, there can be holes. If they were being litigated against, those holes could be used to the claimants advantage. So, having iConsentu, it definitely ticks a big box but from an insurance companies perspective, it gets rid of a lot of the spurious claims, where actually if you look at the procedure it has been done to a good standard. Maybe the only thing that was missing was the documentation and consent is a big part of that. It would get rid of a lot of the cases where ultimately, it just came down to poor record-keeping and poor consent, but otherwise would be a very defendable or defensible claim.
Having iConsentu ticks a very big box, and I think that’s struck a chord with a lot of people. I think in any circumstance, in any situation where a person engages contractually with someone else, having that extra layer of security gives peace of mind to every party involved.