Although it's widely understood that obtaining consent is a cornerstone of good clinical practice, there's often confusion around how to make sure consent is valid.

The best starting point is not to think of consent as a stand-alone issue. It is inextricably linked to the vital clinical skills of diagnosing, treatment planning and good communication.

Talking about treatment

When discussing treatment options with a patient, it's important to explain the risks and benefits that apply to them.

Part of this discussion should include the consequences of failure. It's impossible for every course of treatment to be 100% successful. Many patients will be told of the percentage risk of failure, but it's also important to explain what that failure would mean to them.

For example, if a crown fails, are they likely to need to have the tooth extracted? What about the consequences of post-operative pain following treatment - how likely is it to happen, how severe might it be and how long might it last for?

Montgomery and McCulloch

There have been so many articles written about the Montgomery judgment, it can seem overwhelming, but if you stick to the principles of good communication, you will be on a sound footing.

Remember, the current GDC Standards for the Dental Team came into force before the Montgomery judgement. Standard 3.1.3. says, "You should find out what your patients want to know as well as what you think they need to know."

This is a good way to think about how to apply the Montgomery judgment when obtaining consent. You do not need to discuss every risk with a patient, but you need to put yourself in their shoes and think which risks are going to be important for them.

This can be one of the most difficult things for a clinician to do, because you need to stop thinking as the care provider and start thinking from the perspective of the individual receiving care.

Another urban myth that has developed is that you always need to give every patient a full list of every possible treatment option, including always giving the option of no treatment. This is wrong, and the McCulloch judgment has confirmed that this is wrong.

This judgment is good news for the profession. It confirms that when deciding which treatment options should be discussed with a patient, you only need to discuss the options you think are appropriate.

A good example of this would be explaining the options for treating a patient who is in pain, but not telling them that one option is for you to do nothing.

You might need to explain why you have decided which options are appropriate or inappropriate, especially if a patient obtains a second opinion - but as long as you have good clinical justification for your decision, you should not be criticised for having made it.

Although it's important to make a record of the discussions you have with patients, you do not need to get them to sign a consent form, unless you are providing treatment under sedation or general anaesthetic.

If you do want to use a consent form, as you would in your discussions with a patient, make sure the language used can be understood by them, and be very careful about using jargon.

This can be tricky, as we forget that some terms are not readily understood by patients because we use them day in and day out. Any technical words, including the names of materials, should be explained to a patient in a way they can understand. If you don't do this, your consent form might make it more difficult for you to show you got consent.

Also, avoid catch-all phrases in consent forms like, "I have been informed about all the risks and benefits of the proposed treatment." It is much better to take the time to discuss the risks and benefits of the treatment than to rely on a signature on a form.

Conclusion

There is no single way to obtain consent. It is necessary to tailor your approach to the individual patient, but to stick to the basics of a good diagnosis, a good treatment plan, and good discussions with the patient.

It is also vital to remember that it is not a 'one off' procedure. You need to check each time you see a patient that they understand what you plan to do and agree to you doing it.

Finally, remember that consent can be withdrawn at any time, so if a patient signals for you to stop, you must stop immediately. It is therefore good to warn a patient if you are reaching a point where it would be unsafe to stop until you have completed that item of care.