How to Obtain Informed Consent

Healthcare laws and best practices have been changing rapidly over the last couple of decades.

Patient rights are protected by complicated laws that, when not followed, can result in stiff penalties and criminal charges.

It is more important than ever to gain a full understanding of how the law defines patient consent to treatment and the responsibilities of health care workers to properly obtain informed consent.

The Process
A patient’s consent to treatment is more than simply getting the patient to sign a form.

It is a communication process between the patient and all healthcare providers involved.

In many cases there are several care providers involved with the patient’s care, including nurses, physician assistants, technicians, and physicians.

Each of the care providers will likely take part in the discussion with the patient at some point, but the physician who is providing the treatment holds full responsibility for properly obtaining consent.

If the patient is unable to understand and make decisions, there will be decision makers involved in the communication process, also.

The process for obtaining consent requires of a two-way conversation between the care provider and the patient or representative.

This conversation is an opportunity to clarify medical history and identify concerns, as well as inform the patient on procedures.

The patient and physician should discuss any factors that may cause the patient to refuse or the physician to reconsider treatment options.

Once there is a full understanding and agreement between the patient and physician, the consent can be put into writing on a form or in the patient’s electronic medical record.

Core Elements
Laws and best practices for obtaining consent vary slightly from state to state, but they all include a 2-way conversation between the patient and care provider.

The conversation should contain these essential core elements.

Those elements include:

  • Description of the reason for treatment;
  • Explanation of the test or treatment;
  • Explanation of possible benefits and risks;
  • Description of alternative treatments with their benefits and risks;
  • Description of consequences if treatment is declined.

Along with these core elements for discussion, the physician must also obtain:

  • A full medical history on the patient to avoid ordering tests that can harm the patient or duplication of tests.
  • The patient’s full medication list, including over-the-counter, vitamins, and homeopathic remedies to avoid contraindications.
  • Current social or economic status of the patient to gain a full understanding of the financial stress, personal constraints, and other factors that may affect their decision to consent or decline treatment.

The physician presiding over the patient’s test or treatment is responsible for ensuring that each element is covered during the discussion with the patient or representative.

The Art of Communication
The communication process will vary from patient to patient.

Each individual has a different set of circumstances that will affect their ability to make an informed decision.

The consent process should address the needs of the patient.

Providers must take into consideration all of the aspects of the patient’s life and the best way to communicate with them.

Decision Making Tools: Tools may be used, including brochures, videos, websites, or other learning aids, to educate the patient.

This is often a good way to communicate details about the treatment, the benefits, and the risks.

Carefully gauge the patient’s abilities and personality before choosing a learning tool to avoid insulting the patient’s intelligence or confusing the patient with the wrong tools.

The “One Voice” Approach: Use caution when more than one care provider is involved.

Patients often assume that one provider has given all information to the other providers.

Typically, this is not the case.  When several providers are involved, there is opportunity for misunderstanding by the patient and miscommunication between providers.

The “One Voice” approach simplifies the conversation by assigning one person to deliver the information and ask the questions.

Usually, the physician in charge is the best person to conduct the entire consent communication.

Keep it Simple: While speaking with the patient, use understandable language that is not condescending.

Avoid medical jargon.

Ask questions during the conversation to assess the patient’s comprehension of what was just said.

Provide other sources of information for the patient to research on their own, such as a book, brochure, website, or video.

Remain available to answer questions after the initial conversation.

Informed consent is not a signed piece of paper –

It is the process of obtaining an agreement that is the result of a discussion that includes an exchange of information.

The discussion must be specific to the patient and the process of obtaining consent must directly address the needs of the patient.

Healthcare providers have a legal and ethical duty to follow the process of obtaining consent without leaving out any of the core elements.

Every patient has the right to consent or decline treatment after they have been properly informed.

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Dr. Sameer Thukral

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Dr. Sameer Thukral has completed his MDS in 2010. He holds a Masters Degree Certificate in Dental Lasers from the University of Vienna. He is also a Fellow of the ICOI. He is currently into private practice in Pune, a practice which is now 29 years old. They work as a team comprising of specialists in every field allowing them to cover all aspects of dentistry. Dr. Sameer Thukral’s focus in the practice comprises of Dental Implants and Cosmetic Dentistry including Smile Makeovers.
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    Dr. Sanghamitra is a Fellow and Diplomate of ICOI (USA), founder member of Global Academy of Oral Implantology Germany. She also has a Diploma in Laser Dentistry. She has worked as a former consulting Implantologist at Regency Hospital Dar-es Salam, Tanzania. She is a former Prof. and Head of the Dept. of Oral & Maxillofacial Surgery at Vydehi Dental College, Bangalore. She has successfully conducted courses on various subjects of dentistry - Nationally and Internationally. She specializes in oral and maxillofacial surgery, implants, cosmetic dentistry and laser dentistry.

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    Dr. Purvi Patel a General Dental Practitoner has been practising Dentistry since 12 years. After an year of opening her clinic (Shanti Dental Clinic in 2013) she realised that there is more to running a successful dental practice than just good clinical skills. Dental Business Masters changed her vision and she rebranded her practice in 2018 as NURTURE Family Dental Clinic . After winning the third place at the DBM Speakers Academy, she has been given the opportunity to help dentist achieve their goals to build better teams , that follow proper systems to give the ultimate patient experience.
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        Dr. Mandar Joglekar

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        Dr.Mandar Joglekar has his private practice in Chinchwad since the last 19 years . He has an implant and grafting certificate from Bern University ,Switzerland. He conducts endodontics and microscope dentistry courses and is also India national leader for dentinal tubules study club. He believes as dentistry in India is growing with technology and digital revolution, dentists are facing a few challenges as well! Helping dentists in learning ethical selling, communication skills, showcasing, digital marketing and understanding & growing their businesses is what is his forte.

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              Dr. Vishal Gupta is a renowned Dentist in VIP Road, Zirakpur. He has helped numerous patients in his 20 years of experience as a Dentist. He studied and completed MDS - Orthodontics, MDS from All India Institute of Medical Sciences, New Delhi in 2004 . He is currently associated with V'Shals Dental World in VIP Road, Zirakpur. As a speaker he has participated in courses and conferences both at national and international level. He is a certified Style Italiano level 1 trainer on Direct Restorative Procedure and has earned a silver and green badge from Restorative Implant Practice Excellence. He has various clinical publications to his credit and has made contributions in a book. He conducts continuous dental education courses on various aspects of Esthetic Dentistry.

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              Dr. Sarthak Kadel is a reputed Dental Surgeon, Endodontist and Restorative Dentist in Surat with over 12 years of experience. He has been bestowed with Best dentist in taluka place - 2014 award. He has pursued his BDS from Maitri College of Dentistry and Research Centre in 2010. He currently practices at Dr. Kadel's The Dental Care in Adajan Dn(Surat). He holds membership of Indian Dental Association.

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                  Dr. Chris Barrow obtained his dental degree in India and has enjoyed a successful career in dentistry for the past 23 years. After gaining experience in India and UK whilst working in small as well as large corporate dental clinics, he decided to run his own practice in the UK, where he is the owner of Dental Concepts, a thriving dental practice in Whitchurch. His practice is on a growth path with the more clinics opening soon in UK, the next one opened in Andover last February 2016. The new practice in Andover is an Advanced state of the art centre with all the latest technology available. Besides growing his dental practice, Chris is passionate about sharing knowledge and resources with other dentists in the brand new spacious education centre at Andover and has also run many training programmes in Oxford and Hampshire in the areas of clinical governance, dental business best practices and designing the best possible patient journey within the economic framework of a dental practice.
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                  A Dental Graduate from the University of Pune and fellowship holder from the International Society for Quality in Healthcare (ISQua), Dr.Sameer has been running a successful private dental practice since 1997. Excellent patient care, quality standards in dental practice, and a heartfelt mission to change the face of the Healthcare industry where every patient receives the highest Quality of Care is what motivated him to establish DBM.
                  His Clinic is the first Dental Practice in Maharashtra (India) to comply with the International standards of healthcare quality & safety and Secure the Accreditation Certificate from NABH (National Accreditation Board for Hospitals & Healthcare Providers). His pursuit is to share his knowledge of the systems and protocols in a dental setup for optimal patient care and educate more Dentists to achieve the facet to deliver healthcare in the way it is delivered in the best practices throughout the world. He has currently helped numerous Dentists to achieve accreditation with his consultation and guided mentorship. Silence, Curiosity for learning new things, and absolute perfection in everything he does are the qualities that describe him the best. He spends most of his time learning about software and websites and upgrading the healthcare system when he is not working.

                  Dr. Manish Chitnis

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                  Dr Manish Chitnis obtained his dental degree in India and has enjoyed a successful career in dentistry for the past 23 years. After gaining experience in India and UK whilst working in small as well as large corporate dental clinics, he decided to run his own practice in the UK, where he is the owner of Dental Concepts, a thriving dental practice in Whitchurch. His practice is on a growth path with the more clinics opening soon in UK, the next one opened in Andover last February 2016. The new practice in Andover is an Advanced state of the art centre with all the latest technology available. Besides growing his dental practice, Manish is passionate about sharing knowledge and resources with other dentists in the brand new spacious education centre at Andover and has also run many training programmes in Oxford and Hampshire in the areas of clinical governance, dental business best practices and designing the best possible patient journey within the economic framework of a dental practice.
                  He is a keen Table Tennis player playing for the local club and has recently completed a once in a lifetime Survival Expedition in the deserts of Oman. He is a proud father of a teenager son and has a lovely wife, Shilpa who is the Co-owner of Dental Concepts.

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                      Dr. Sarthak Kadel

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                      I have been a General Dentist for over 17 years. Practised in Mumbai for 4 years and then moved to the UK in 2005. Finished International qualifying exam - 2006 Passed MJDF in 2007 Worked as a GDP in a corporate practice (former ADP now My dentist) from September 2006 till 2010. Along with my husband we bought a family run mixed dental practice from September 2010 (Dental Concepts Whitchurch) We started a squat private practice in Andover in 2016. Have been updating my clinical skills by doing cosmetic hands on courses and the Invisalign course.
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                      I am very keen to make a difference for my colleagues who feel pressured or stressed or want direction in their career. I have worked with my team using and understanding personality profiles and emotional intelligence. This has helped strengthen the team. With these results, I have also worked with over 50 dentists in India. I have recently started working with few dentists here in the UK. I have conducted goal setting workshops for few of my dentist colleagues.

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                        A student of Government Dental College & Hospital. Mumbai, Dr. Rajiv Verma is in the field of dentistry for 34 long years, his command on the subject of Clinical Prosthodontics has been witnessed till date by more than 30000+ dentists & 2300+ hands-on course participants in his 450+ lectures, presentations, live on patient demos, live on video shows of Porcelain Veneers, Crown'n'Bridge & DSD - Digital Smile Design .
                        A clinician for 30 years, a dental ceramist of repute for 21 years, a IDA Speaker for 19 years, a course conductor for 13 years, an international Speaker for last 6 years, an author of 2 books, it is not over yet his latest title is of a DSD - Digital Smile Design Master & DSD Lecturer of Asia/India. A key Thought Leader for Colgate, a National Consultant to a social project by Global Protect Dental Private Limited & what not. His new & forthcoming ventures - a column titled RVG - Rajiv Verma Gyan in Famdent Magazine & a Concept Bur Box in making. Life has been a crazy journey till now.

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                            Dr. Ajit Shetty

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                            Dr. Ajit Shetty graduated and Post graduated from Government Dental College and Hospital, Mumbai Fellow and Diplomate, International College of Oral Implantologists, (USA) Fellow and Diplomate, Indian Society Of Oral Implantologists. His areas of excellence include- Aesthetic Dentistry, Implants and Full Mouth Rehabilitation and Lasers. He conducts Extensive training in Oral Implantology all over the world in Singapore, Germany, Denmark, USA etc.
                            He Lectures extensively and conducts several Hands on Courses and Live Clinical Demonstrations all over India and abroad for dental colleagues on Aesthetic Dentistry ,Implants, Occlusion and Lasers and Practice Management. Past President of Indian Dental Association, Mumbai. He has Held various posts in the association at city, state and national level.he was also the Founder member and Past President of the Indian Academy of Aesthetic and Cosmetic Dentistry.

                            Dr. Diksha Batra

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                              Dr. Diksha Batra

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                              MDS IN PROSTHODONTICS, FICOI | CLINICAL DIRECTOR "SMILE ESSENTIALS"
                              Dr. Diksha Batra is a prosthodontist by education and a clinician practicing for over a decade in Mumbai, India. A decade of rich and diverse dental experience led her to pioneer the unique field of Pain-free dentistry in India. She is fondly called The Painfree Dentist” for pioneering work in eradicating dental phobia. Her award-winning practice is home to thousands of national & international patients and was ranked amongst the top three dental clinics in Mumbai as per the “Times All India Lifestyle Hospital & Clinic Ranking Survey. In December 2015, Dr. Diksha Batra founded “Angel Dentists Network”, India’s 1st All Dental NGO. Started in the bylanes of the suburbs of Mumbai, the ADN family has grown and spread smiles to our Nation’s Capital – Delhi, Pune & Ladakh.

                              Dr. Aditi Mahale

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                              Dr.Aditi Mahale is Practising Dentistry since 2009 at Dombivli. She owns DentA-Zone Dental & Implant Clinic, a 2 chair set up. Joined Dental Business Masters in 2016 and there's no looking back since then. She won the DBM Best Marketing Genius Award 2016-17. DBM played a vital role not only in improving Finances but also Various other aspects of Dental Practice Management. Being appointed as DBM Coach was a proud moment. Her motto is to keep working consistently to get the results. Dr. Aditi is also associated with various organisations and is committee member of IDA DOMBIVLI. Member of BNI & Rotary International. She is mother of Son, Abhedya. Dr.Yogesh , MDS Prosthodontist, her husband is co-owner of Dentazone.

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