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How to enhance recall and comprehension of orthodontic consent to minimise allegation?

The Principles of General Dental Council (GDC) in the UK

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

GDC principle No. 3

It states that dentist should:

1. Obtain valid consent before starting any treatment or investigation.

2. Document the discussions in the process of gaining consent.

3. Consent should include:

• Options for treatment,

• Risks and the potential benefits,

• Why you think a particular treatment is necessary and appropriate for them;

• The likely prognosis;

• Your recommended option;

• Cost of the proposed treatment,

• Consequence of no treatment,

• Whether the treatment is guaranteed.

Verbal or written consent?

Legally, verbal consent is just as valid as written consent though not recommended but you must obtain written consent where treatment involves conscious sedation or general anaesthetic.

Causes of allegation in orthodontics

• Poor communication is the major factor for patient complaints. Poor communication relates to three main categories; miscommunication, no communication and inattentive listening to patients. According to BOS 2010-2011, 40% of the 108 more serious calls were precipitated by a breakdown in communications either during or after treatment.

• Lack of informed consent.

• Poor record-keeping.

• Misleading statements.

• Carrying out ‘experimental’ treatments without properly informing the patients of alternatives.

• Advertising incorrectly.

• Fraudulent claims / charges.

• Most patient complaints do not involve operator error, but are made due to patient expectations not been met.

Consent requirements (The role of CIA)

Competent patients

Informed consent (Simply signing a document for legal purposes does not mean the patient understands treatment; therefore, the provider can still be liable for not properly informing the patient)

Autonomy of the patient should be granted

Methods to meet the consent requirements

• Verbal

• Audio

• Video

• Printed leaflets (written)

Studies showed that whether the information was given in a written, visual, or verbal form had no effect on information retention (Thomson et al. 2001) though aduiovisual had better comprehension, even in patients with lower education levels (Rossi et al. 2004)

Recently, there is a move toward rehearsal and active participation of the patients in the consent process to increase recall and comprehension of orthodontic informed consent.


AJODO in its September 2020 issue published a paper to assess ways to improve orthodontist-patient communication and obtaining a valid informed consent.

The paper titled (Rehearsal's effect on recall and comprehension of orthodontic informed consent). The project was led by Dr Skulski from USA. The tested methods were rehearsal- and audiovisual-base (traditional) methods.

In summary

The rehearsal method is legal/efficient method and it improved recall and comprehension of informed consent and reduced anxiety of the patients in comparison to traditional method in obtaining an informed consent.

Link to the paper

Recent addition

There is a new interesting and potentially promising App called iConsentu.

iConsentu has been developed collaboratively by Leeds University, Medico-Legal advisors and by Doctors and Dentists in NHS, Private and Hospital practice. The aim is to ensure patients receive the most up to date treatment information in a manner that they can readily digest and fully understand to allow them to give valid informed consent.

The application has been designed to test patients’ understanding of each procedure, using simple animation followed by a question and answer stage, allowing treatment to proceed in confidence.

I heard that there is an ongoing study in the UK to assess the effectiveness of this App.

PS: I have no financial interest.

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