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What is Informed Consent? (UK and Ireland)

letsconnect

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In May 2005, the General Dental Council (GDC) lauched new guidance documents for UK dental professionals (which they are supposed to have read and adhere to). Of particular interest is the booklet "Principles of Patient Consent", which accompanies the core guidance document "Standards for Dental Professionals". The full guidance documents can be downloaded on the GDC's website (www.gdc-uk.org). The below are excerpts from "Principles of Patient Consent":


Our standard guidance, 'Standards for dental professionals', sets out six main principles which you should apply to all aspects of your work as a dental professional.

It is your responsibility to apply the principles to your daily work, using your judgement in the light of the principles.

The guidance says:

'Respect patients' dignity and choice'

* Treat patients politely and with respect, in recognition of their dignity and rights as individuals.
* Recognise and promote patients' responsibility for making decisions about their bodies, their priorities and their care, making sure you do not take any steps without patients' consent (permission).


It is a general legal and ethical principle that you must get valid consent before starting treatment or physical investigation, or providing personal care, for a patient. This principle reflects the right of patients to decide what happens to their own bodies, and is an essential part of good practice.

Patients have the right to choose whether or not to accept your advice or treatment. The guidance identifies, and is limited to, the ethical principles of getting patient consent which you should apply to your work. It cannot cover all situations.


1 Informed consent

1.1 For consent to be valid, the patient must have received enough information to make the decision. This is what we mean by 'informed consent'.

1.2 You should give patients the information they want and need, in a way they can use, so that they are able to make informed decisions about their case.

1.3 Giving and getting consent is a process, not a one-off event. It should be part of an ongoing discussion between you and the patient.

1.4 Find out what your patients want to know, as well as telling them what you think they need to know. Examples of information which patients may want to know include:

* why you think a proposed treatment is necessary
* the risks and benefits of the proposed treatment
* what might happen if the treatment is not carried out
and
* other forms of treatment, their risks and benefits, and whether or not you consider the treatment is appropriate.


1.5 Always make clear to the patient:
* the nature of the contract, and in particular whether the patient is being accepted for treatment under the NHS or privately; and
* the charge for an initial consultation and the probable cost of further treatment.


1.6 Whenever a patient is returning for treatment following an examination or assessment, give them a written treatment plan and cost estimate.

1.7 If, having agreed an estimate with the patient, you think that you will need to change the treatment plan, make sure you get the patient's consent to any further treatment and extra cost and give the patient an amended written treatment plan and estimate.

1.8 Giving a patient clear information to help them make a decision may involve using written material, visual or other aids.

1.9 Try to meet particular communication needs, for example, by suggesting that the patient brings a friend who can sign or interpret for them, or providing a hearing 'loop'.

1.10 Satisfy yourself that the patient has understood the information you have given them.

1.11 Consider whether they would like more information before making a decision, and whether they would like more time before making a decision.

1.12 Respond honestly and fully to any questions the patient has.

1.13 Involve other members of the dental team in the discussion with the patient, where appropriate. They may have valuable knowledge about the patient's background and particular concerns.


2 Voluntary decision-making

2.1 The patient must make the decision.

2.2 Do not pressurise the patient to accept your advice.

2.3 Patients have a right to refuse to give consent for an investigation or treatment. If they do so, you should respect this decision.

2.4 Once a patient has given consent, they may withdraw it at any time, including during the procedure.

2.5 Make sure that once the patient has given consent, they know how to review the decision with the person providing the treatment.

2.6 Make sure that you are clear how much authority they have given you. For example, whether the patient agrees to all or only part of a proposed treatment plan.
 
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Re: Principles of Informed Consent (UK)

Attached below are both the GDC's "Standards for Dental Professionals" and "Principles of Patient Consent". These apply in the UK. You can download the PDF files by simply clicking on them.
 

Attachments

brit

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NEW GDC Standards

Some good changes made here: feel free to read it and post the ones you like...it will save me a job...it seems some of our feedback was actually taken into account.

NINE Main principles which are fully explained in subsections:
1 Put patients’ interests first
2 Communicate effectively with patients
3 Obtain valid consent
4 Maintain and protect patients’ information
5 Have a clear and effective complaints procedure
6 Work with colleagues in a way that
is in patients’ best interests
7 Maintain, develop and work within
your professional knowledge and skills
8 Raise concerns if patients are at risk
9 Make sure your personal behaviour maintains
patients’ confidence in you and the dental profession



My favourite is:
Patients expect: Principle One page 10: Patients' Expectations 'That their dental pain and anxiety will be managed appropriately'

Standard 1.2

You must treat every patient with dignity and respect at all times
1.2.1 You should be aware of how your tone of voice and body
language might be perceived.
1.2.2 You should take patients’ preferences into account and
be sensitive to their individual needs and values.
1.2.3 You must treat patients with kindness and compassion.
1.2.4 You should manage patients’ dental pain and anxiety
appropriately
 
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C

comfortdentist

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Re: NEW GDC Standards

It's amazing that they have to write the standard that should be obvious.
It is sort of liking mandatory ethics course.
 
brit

brit

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Re: NEW GDC Standards

It's amazing that they have to write the standard that should be obvious.
It is sort of liking mandatory ethics course.
Yes it always said 'patients should be treated with respect' but at least now it gives lots of examples of what that means in practice. It is necessary especially for non-UK trained dentists i.m.h.o. especially on the right to pain relief issue.

The GDC is the nationwide body which regulates dentists in the UK. If patients make complaints they do take the issues forward and dentists ignore these guidelines at their peril as when appropriate the GDC does strike dentists off the Register and impose conditions on practice.

I hardly think the USA has the moral highground on dental ethics given what is apparently happening in the medicaid arena: millions of dollar claims for orthodontic treatment on baby teeth in Texas etc etc. and various other Corporate abuses.
 
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I

irmemac

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Re: NEW GDC Standards

Thank you for posting these, Brit. It is really interesting (and helpful) for patients to know this.
 
vicki

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Re: NEW GDC Standards

Very useful to know, so thank you for posting it :).

I actually find it quite sad that it's come to this though; most of those items come under the categories of 'common sense' and 'treating others as you would wish to be treated yourself', both of which I would've thought were prerequisites for anyone wanting to train and work in dentistry, or indeed in any other 'caring' profession.

Then again, we live in a country where patients can die from dehydration and starvation in hospital because the nurses forget about them and in some hospitals, the doctors have to prescribe water for their patients in order to make sure that the nurses give them something to drink. :o
 
brit

brit

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Re: NEW GDC Standards

Then again, we live in a country where patients can die from dehydration and starvation in hospital because the nurses forget about them and in some hospitals, the doctors have to prescribe water for their patients in order to make sure that the nurses give them something to drink. :o
Exactly - the idea of someone drinking out of a flower vase will stick with me forever from Stafford case whether it were true or not.
I think spelling it out gives patients grounds they can cite when making a complaint/giving feedback.

For balance I should add that all my NHS medical experiences since returning from abroad have been good. All doctors/consultants (I've seen about 10 if I count the ones for other relatives where I have been present) have good people skills and have been pleasant and competent.
 
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brit

brit

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Re: NEW GDC Standards


'Standards for the Dental Team' replaced 'Standards for Dental Professionals' on 30 September 2013.

Principles remain the same:
1 Put patients’ interests first
2 Communicate effectively with patients
3 Obtain valid consent
4 Maintain and protect patients’ information
5 Have a clear and effective complaints procedure
6 Work with colleagues in a way that
is in patients’ best interests
7 Maintain, develop and work within
your professional knowledge and skills
8 Raise concerns if patients are at risk
9 Make sure your personal behaviour maintains
patients’ confidence in you and the dental profession.

This is just a flavour:
Standard 1.1
You must listen to your patients
1.1.1 You must discuss treatment options with patients and
listen carefully to what they say. Give them the opportunity
to have a discussion and to ask questions.



Standard 1.2
You must treat every patient with dignity and respect at all times
1.2.1 You should be aware of how your tone of voice and body
language might be perceived.
1.2.2 You should take patients’ preferences into account and
be sensitive to their individual needs and values.
1.2.3 You must treat patients with kindness and compassion.
1.2.4 You should manage patients’ dental pain and anxiety
appropriately
 
Last edited:
letsconnect

letsconnect

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Re: Principles of Informed Consent (UK)

As mentioned by Brit, the General Dental Council launched "Standards for the Dental Team" on 30 September 2013. It replaces Standards for dental professionals and its supplementary guidance booklets (eg Principles of patient consent) published in 2005.

The information hasn't really changed (if anything, it is now even more detailed).

You can download the PDF file here: View attachment NEW Standards for the Dental Team.pdf

The equivalent document for Ireland is called "Code of Practice relating to: Professional Behaviour and Ethical Conduct - Promoting transparency and enhancing public confidence in the dental profession" (February 2012). It can be viewed here.
 
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