Any service profession requires an ability to listen, diagnose, propose a plan of action, and implement that plan. The sticky part comes between the proposition of a plan of attack and the implementation, because unless the client understands the ins and outs of the plan (the good the bad and the ugly) the plan is, at best, a one sided undertaking by the professional that happens to satisfy the client, and at worst, an unmitigated disaster for the client with the blame falling squarely on the professional. “Informed consent” is what inhabits that space between planning and action and it is probably the most important part of any professional relationship, and really it encompases all of the communication between the “problemed” and “problem-solver” and it can be all too easy for either side to abdicate her/his responsibility.
When I started my career, informed consent seemed to be simply part of your risk management strategy, a check box that needed to be completed in order to mitigate any liability in a treatment plan. While communication was always of paramount importance to me (I felt empathy for my patients and wanted to make sure that their needs were met in the most caring and compassionate way possible), what it took me a while to understand is that all of that is part of informed consent. All of it. My primary job is to make my knowledge accessible to a patient, to be a resource for them to ultimately make the decision as to which course of action is right for them at that moment in their life. I need to give them an accurate picture of what I can and cannot do and what the expected outcomes of various treatment modalities are, including any risks. Only then can a patient place some kind of value on the service being offered and weigh that against the cost (in time, emotional energy, and money) of the plan. I need to be as precise and honest as possible in my assessment and as clear as possible in my communication. And the patient needs to engage in the process actively.
So what does this look like? Well we first need to get to know you, and that process starts with our initial contact with you. We obviously need to get the basics (name, contact info, primary reason for calling or emailing), but we also hope to start to get a deeper picture of who you are and what you hope we can help you with. When you arrive for your first visit, the forms you fill out (or filled out after printing from our website) continue to enrich our understanding of who you are and what your needs are. Next we collect a lot of data through examination but also extensive conversation. Through this process we attempt to keep the communication open in both directions. In a sense we are trying to give you access to our expertise so that you can better understand the state of your health and understand how we might work together to realize optimal health. Once we have a roadmap we can work out the details of treatment sequence, finances, and scheduling.
For some, the preceding paragraph may seem to be missing an acknowledgement of the fear and anxiety that accompany dental experiences for many. In my experience, however, alleviating fear and anxiety is best accomplished through the very steps outlined above. Do people like pain? Of course not, but that is not what I’ve found to be the root of their dental phobia. The unknown, the lack of control combined with the possibility of pain is really the driving force. When we take the time to develop a relationship with a patient and address their dental problems as a team, we can (sometimes with the help of adjunctive treatments like nitrous oxide and/or antianxiety medication) overcome that fear. Once trust is developed a patient (and dentist) can relax, which leads to more comfortable visits. This partnership is the key to successful treatment outcomes as well and it is really what informed consent is all about. You should not settle for less.