My Treatment Plan and Informed Consent Process

During workshops, I often describe the process I use to develop and present a treatment plan for my patients. It is important both patient and dentist have a clear understanding of the possible treatment options so that the patient can make an informed decision regarding their treatment.

The ADA Code of Professional Conduct requires dentists to fulfill their obligation concerning a patient's right to self-determination. This includes providing patients with the proposed treatment and reasonable alternatives so patients can make an informed decision. The plan must use simple terms with the options clearly outlined, should be presented in writing and be fully reviewed with the patient. This process helps to mitigate any potential communication errors. According to the ADA, elements of informed consent include:

• The clinical findings and diagnosis
• Recommended treatment, including costs
• Alternative treatments
• Risks of the treatment
• Risks associated with no treatment

Once the plan is presented and the patient has indicated their choice, it should be signed and kept with the clinical record.

I schedule two or three appointments for my consultation process. While this may seem excessive to some, this collaborative, patient-centered approach provides opportunity to fully engage in the planning process and come to a completely informed treatment decision. Depending on the distance the patient is traveling for treatment, the initial consult may be scheduled as a separate appointment or combined with the comprehensive examination.

After obtaining and reviewing the patient's medical and dental history, I interview the patient to confirm the information they have included and ask probing questions as needed to develop a full picture of their overall medical and dental health. In addition to their medical and dental history, we discuss any concerns the patient may have regarding care and their wants/desires with regards to the outcome of treatment. The next step is a comprehensive exam. During this appointment, we discuss the clinical findings and review how these relate to the patient's desired treatment outcome.

The treatment plan is developed and presented to the patient during their final consult appointment. During this appointment, we review the clinical findings through a guided co-discovery process where I assist the patient in recognizing problems that may be readily apparent and those they may not be able to identify on their own. After the co-discovery process, I present the risks and benefits of each proposed treatment alternative to the patient. The headings on my treatment plans are:

1. Initial Observations: This section includes my clinical findings, and the patients desired treatment outcomes.
2. Referrals: This section outlines all recommended specialist referrals and the recommended treatment each would perform. Potential costs are discussed but not included in my treatment plan fees.
3. Prosthodontic Treatment Plan: This section includes the phases of treatment and the costs associated with each.
4. Narrative of Other Potential Fees: This section includes potential additional treatment needs, which may not be detected or determined until the restorative procedure has begun (example: decay, post and cores, etc.).
5. Payment Terms: This section indicates when during the treatment plan payment will be required and the amount/percentage of the fee due.

After reviewing the plan and providing the patient the chance to ask any questions, the patient may make a decision and sign the treatment plan with their indicated treatment choice or, if they need more time, I encourage them to take the treatment plan with them and contact my office if they have additional questions. If cost is an issue, we discuss how to phase the optimal treatment to be more affordable. Once the patient makes a treatment decision, we schedule them for their first appointment.

I find that by following this process, patients gain a better understanding of their comprehensive dental needs and make an informed decision when committing to treatment.

Robert Winter, D.D.S., is a member of Spear Resident Faculty.