Case study
Estimated read time: 7 mins
Do you lose sleep over how you manage the consent process with your patients? Do you worry that the next patient you see might be the one who complains about you to the General Dental Council?
Imagine if you’ve just spent £1,000s on courses to hone your clinical skills, but the patient cannot see the value of your treatment proposal. How to you react to rejection? Getting the patient to consent can seem like a long way off.
These scenarios have something in common – there’s a problem with your approach to consent.
What is your perspective on consent? Is it a tick-box exercise or is it an opportunity to exercise your communication skills? Many dentists perceive consent as a dentolegal requirement, and failure to obtain consent is seen as a threat to their career
What if we change our perception of consent from a regularity, quasi-legal process, to an opportunity to add value to the dentist-patient interaction. O’Neill describes consent as a ‘propositional attitude’. It is a response to a proposition that is yet to be carried out.1
At its core lies the notion of trust where getting to ‘yes’ is not coercive but a voluntary agreement.
Clear communication is crucial for both consent and trust. Valid consent requires that all parties understand the terms, boundaries, and expectations. Similarly, trust thrives on open, honest communication where individuals feel safe expressing their needs and concerns. It makes work more fulfilling.
I first recognised that gaining consent was a potential threat when working with younger colleagues in the early-mid 2000s. Failing to provide ‘consent’ was associated with the increasing number of legal cases precipitated by the ‘no win, no fee’ offer from law firms.
The reaction of many in the profession was to ‘batten down the hatches’ and take a defensive and cautious approach to their consent process. They wanted to be prepared for the day when that patient might take legal action against them or complain to the GDC. Inevitably, this leads to an erosion of trust between dentist and patient; the dentist probably spent more time writing the clinical notes than they spent communicating the risks and benefits of dentistry with their patients.
Consent was no longer just a procedural issue—it was emotionally exhausting. Some of the most ethically committed dentists I knew were demoralised, and contemplating stepping away from clinical work.
I’ve always felt that treating patients is s a privilege and, encouraged by my experiences at the Pankey Institute, learned the skills to build rich and rewarding relationships with them. Seeing colleagues adopt a defensive, low-trust approach didn’t seem right – and certainly took a lot of fun out the job. Consent is a fundamental part of the ethics of interpersonal relations between dentist and patient. It permits interventions which would otherwise be – to put it simply – wrong.
I wanted to explore different facets of consent and develop and implement a robust consent process to help patients make the best choices for themselves. The first step was to undertake some practice-based research with two colleagues (Nilesh Shah and Nigel Rosenbaum). The study was generously sponsored by The Association of Dental Implantology and published in the FGDP Journal.2 We recognised that consent was really a type of educational journey for the patient – a journey that included an ‘exam’ or ‘test’ to check their understanding of implant related procedures.
Many more years of working, training, and generally chewing the fat with colleagues led me to realise that consent and personalised patient care go hand-in-hand and are inseparable. This reminded me of a philosophy I had been introduced to by Dr Pankey way back in 1982: “Never treat a stranger, only treat a friend”. Instead of making efforts to get to know the patient, many dentists make the huge mistake of seeing consent merely as a legal necessity. There is a legal aspect, of course, but should not be the sole driver of the process for obtaining consent. In my experience, consent is more about focussing on patient-centred care than it is about legal process. The landmark Montgomery v Lanarkshire Health Board [2015] decision supports this view. The case redefined the legal expectations of consent in the UK, emphasising the importance of disclosing material risks and reasonable alternatives as judged from the patient’s perspective.
If you don’t value the consent process in your practice, then you are likely to make it a rushed affair, a tick-box exercise. Patients who ask questions and take up even more of your time become figures of hate. You become frustrated and nudge them to ‘sign on the dotted line.’ (while thinking ‘let me get on with it’).
How would you feel if you were treated like this? As individuals we are much more likely to question authority today – whether it is our politicians, our school leaders, our legal professionals, or our medical practitioners. We expect to be listened to, and our individual needs considered.
Our patients are no different. Prospective patients are searching for practices that will understand them as an individual and help them make the right choices. The patient is a ‘buyer’ of dental treatment and the old mantra caveat emptor – ‘ let the buyer beware’ – applies. Patients will be attracted to dentists who can minimise the anxieties around the purchasing process. Consent then should be seen and respected as an opportunity to build trust and not as a dentolegal threat.
This is a golden time to be a dentist. Our best dentistry combined with simple maintenance can deliver a great looking smile and healthy function for life. What other part of the body can defy the ageing process like the mouth?
So why aren’t patients knocking on our doors to demand our best dentistry?
I qualified in 1980. I have been involved in postgraduate education since becoming a Foundation Trainer in 1987. A lot has changed since then. In my career I have seen a stellar growth in postgraduate courses and the range of qualifications for GDPs to aspire to. It’s no longer acceptable to qualify and never attend a course again. As a result of this education, the high-street GDP can upskill and now deliver high quality dentistry that was once only available from specialist practitioners.
Dentists are investing thousands of pounds and hundreds of hours to acquire the knowledge and skills to offer advanced care and options to their patients and digitalisation. They can formulate detailed treatment plans and present them to patients in technologically advanced settings. For example, using smile simulation software a dentist can show the patient how their smile could look. Patients can then discuss the simulated appearance with their dentist and provide feedback.
Every treatment plan requires the patients to say, ‘yes’ and patients will only say ‘yes’ if they trust the dentist and truly understand the benefits and risks of the plan. The dentist has failed to communicate with the patient, has failed to ‘sell’ the benefits of long-term oral health. The phrase ‘ethical selling’ is contradictory, often interpreted as an oxymoron. The word ‘selling’ has commercial, persuasive, even manipulative connotations — whereas ‘ethical’ invokes impartiality, duty, and trust.
Ethical selling prioritises honesty, transparency, and concern for the patient. It respects patient autonomy and focuses on creating value through the consent process.
An effective consent process is an art and a science. It requires a professional attitude, some knowledge and understanding of the underpinning principles of the consent process and effective communication skills.
And remember, consent is not a one-time event but an ongoing process throughout the patient's care journey. It is important to maintain regular communication with patients, providing updates on treatment progress, and obtaining further consent if any alterations or unexpected situations arise during treatment.
Dentists spend hundreds of hours on developing their clinical skills, but far less time how to improve communication skills and deepen their understanding of ethical principles related to consent. Workshops, seminars, or professional development courses focused on patient communication and ethical practices are equally important when it comes to consent and ethical selling.
Every hour you spend on your consent skills will pay you back with interest – and lots of it. It’s not only about the joy of delivering your best dentistry, but also the quality of the caring relationship you will build with your patients. Patients are far more likely to accept treatment recommendations when they understand the rationale behind them, feel listened to, involved in the decision without feeling rushed or pressured.
You can make consent a huge opportunity to transform your dental career.
Modern dental practice has moved beyond the paternalistic model, where clinicians made decisions on behalf of patients with limited discussion. Today, we adopt a patient-centred approach that emphasises shared decision-making and informed consent as fundamental components of high-quality care. From a commercial perspective, this shift supports increased treatment uptake and helps build a stronger professional reputation.
You can contact Dr Andy Toy to find out about his personal development courses via email here.
References
O O'Neill, ‘Some limits of informed consent’ (2003) 29 (1) Journal of Medical Ethics 4, 5
2015: ‘Consent for Simple Dental Implant Treatment: Matching Practice with Theory’ Toy AC, Shah NR, Rosenbaum N, Dennick R; Primary Dental Journal (FGDP(UK) 2015 4, 1 pp19-25