The American Medical Association defines Informed Consent as "more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention." So what does this have to do with you as a dental patient?
How informed are you?
Let's develop this further. For example, do you fully understand all the procedures, techniques and time commitments of your proposed dental treatment? Are you informed of all the risks, benefits and options available for each procedure? Are you made aware of what dental materials are being used and how they may impact your health? Most of all, is everything in writing and signed by you and your dentist? If any of the previous questions were answered with a "no", then you must read further.
Your mouth is the "gateway to your body" and plays a much more important role for achieving good overall health than most people realize. Eating properly, good digestion, speaking, smiling and so much more depend on a healthy oral condition.
Studies today indicate that certain dental conditions are risk factors for heart disease, stroke, neurological problems, obesity, diabetes,pre-term and low birth weight babies, headaches, facial pain and more.
No place for dentistry
Dentistry has been in the past considered to be the forgotten child in the medical world. Medical doctors are not trained at all about the mouth and its impact on health while dentists, by licensure, are limited to treating issues only within the head and neck areas.
Dental insurance coverage is poor and medical insurance doesn't cover dental therapies (except Health Savings Accounts). As a matter of fact, many employers are eliminating dental benefits altogether.
Therefore, becoming a more educated, knowledgeable consumer is now your responsibility. Having awareness of all the issues allows you choice in making your healthcare decisions. After all, it is your body and you should know what is being done to it at all times. And it starts with Informed Consent.
The right beginning
The initial examination and related diagnostic tests are the first steps for gathering information. A good medical and dental history is vitally important. This history not only includes your chief dental complaint but also your chief medical complaint, including listing of surgeries, medications, past illnesses, family health issues and total body system reviews.
The history should be reviewed by you and your dentist with you being informed of how any dental procedure may impact your health. Appropriate referrals should be made to other qualified practitioners if indicated. This form should then be signed and dated by you and your dentist making sure this extremely important step has been completed.
You are doing what to me?
The treatment plan that follows provides the blueprint for how your dentist is going to address your dental needs. A separate appointment should be scheduled with your dentist, not an assistant or office manager, to go over in depth what the treatment recommendations are. Time needs to be spent going over the risks, benefits and options for all aspects of the proposed treatment.
You should be given supporting materials such as models, graphs, photos, brochures ...etc. that fully support your treatment decisions. Fees should be discussed upfront, along with payment options and insurance contributions, and accepted by both parties. When you are both satisfied with the agreement, you and your dentist should sign and date the document.
It is a good idea to bring a tape recorder with you to that visit allowing you to review this discussion you had with your dentist. If finances are being discussed, it makes good sense to bring your partner with you at that visit to avoid any possible misunderstandings.
As time goes on...
As treatment progresses always maintain good communication with your dentist and the staff. Keep asking questions until you feel that they all have been answered. You have the right to ask any question you may have. Any time your treatment plan changes; it must be discussed fully in advance. Everything needs to be understood and accepted by you and your dentist. And yes, get it in writing and signed!
Through informed consent, you will gain an understanding of all aspects of your proposed dental treatment ultimately resulting in a more favorable outcome. You can now become an informed consumer in charge of your own health and that is the first step toward a healthier smile!
Informed Consent For Surgery
Neuropsychological testing measures the athlete's cognitive flexibility, attention span, orientation, concentration, visual-spatial capacity, distractibility, immediate memory recall, and problem-solving abilities.
These tests directly measure the cognitive qualities that are affected by head injury and allow athletic trainers to objectively evaluate the athlete's condition.
The administration of these tests generally occurs in a clinical setting, although recent research indicates that athletic trainers may also administer neuropsychological tests on the sidelines and achieve valid results. The National Football League and National Hockey League currently use neuropsychological testing to assess professional athletes' cognitive abilities, establishing that it is reasonable to employ these tests as a standard for assessing, treating, and making return-to-play decisions.
Similarly, researchers have established that postural stability tests are reasonable to use in determining when symptoms of concussion cease. These objective tests use sophisticated force plate systems to challenge sensory systems involved in balance by altering visual and support surface conditions.
Although it may not be reasonable to expect the average athletic trainer to have access to this type of equipment, research indicates that there is a significant correlation between the results of simple tests that the athletic trainer can conduct on the sideline and the results of sophisticated postural stability tests.
One of the reasons that athletic trainers rely so heavily on subjective measures and personal intuition when evaluating an athlete with a head injury is that they have nothing for comparison. Athletic trainers and team physicians routinely conduct pre-participation examinations to determine if an athlete has a condition that would preclude participation in sports.
Although reported legal decisions provide little guidance regarding the appropriate nature and scope of a standard pre-participation examination, many lawsuits allege that the sports medicine professional did not discover a medical condition that later resulted in injury or death.
Informed Consent
Generally the law has found that physicians who conduct a thorough pre-participation examination in conformity with accepted standards of practice are not liable for the athlete's injuries that occurred post examination.
Sports medicine professionals should always consider the intensity and physical demands of the athlete's sport, all objective clinical evidence, and the probability and severity of harm from athletic participation given the athlete's condition. Failure to provide an athlete with full disclosure of material information about playing a sport with a medical condition or the potential consequences creates liability for negligence. This duty to disclose relevant information relates to the issue of informed consent.
Informed consent is usually a defense for assault and battery, but courts have translated this concept into negligence terminology. Informed consent comes from the public policy that a competent adult has the legal right to determine what to do with their body. As such, adults may provide consent, but minors require consent by a parent or guardian.
The consent must represent an informed decision regarding the risks of treatment and participation. For an athlete's decision to be informed, the sports medicine professional must clearly warn of all material, short-term, and long-term medical risks of continued athletic participation under the circumstances. Athletic trainers and team physicians can share liability if more than one person, other than the athlete, contributed to any injury.
If negligence can be associated to a sports accident or injury there are potential damages, which the injured party can collect. The athlete must prove by a preponderance of the evidence that a breach of some type was in fact the legal cause of the injury.
In a negligence case, the injured party generally seeks financial damages for the following areas: past, present, and future pain and suffering; past, present, and future medical expenses; and past, present, and future diminution of earning cap.
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