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Informed consent in Dental School

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 Finding the perfect balance of informed consent can be a challenge, even to the most qualified of dentists. As a D3 student, I have found many obstacles in balancing: education of patients with appointment time and the patient’s personal preference. And in the end all of these efforts can be unhinged if a professor does not agree with your treatment plan. Informed consent is a process I take very seriously and will always present the possible options to a patient before the patient makes a final decision. I want to run though a stressful scenario I have encountered during my time in dental school and hopefully prevent this from happening to you.   

 

Scenario #1: 23 year old patient with poor oral hygiene, poorly controlled type 1 diabetes, rampant decay (every tooth in the mouth has caries with many hopeless teeth). The series of treatment plans we came up with included: 1. Extraction of hopeless teeth, implants to replace teeth, crowns on remaining teeth, 2. Extraction of hopeless teeth, partial denture to replace teeth and crowns on remaining teeth or 3. Extraction of all maxillary teeth, full maxillary denture, extraction of hopeless mandibular teeth, crown remaining mandibular teeth and mandibular partial denture.

The patient choose treatment plan #2, but this was the treatment plan that the faculty was in favor of and so the patient was inclined to choose it. This treatment plan is a good option, but the patient was supposed to make the decision not the faculty. As we progressed to operative to excavate and sedate caries on multiple teeth the faculty that day did not agree with our treatment plan and believed that a full denture would be a better fit for the patient. This upset the patient and no work was completed that day. The following operative appointment with a different faculty member, the patient now told me that she wants to go with the option of a full denture after discussing it with a relative that has been through a similar experience. But the faculty that we worked with that day did not agree that she should get a full denture. The patient and myself are frustrated and confused by this back and forth treatment plan.

This scenario is a major problem in dental school and many students have had a similar experience. As students we do not make the final decision and this can be frustrating to both the student and the patient. We spend the time explaining the cost and benefits of each treatment plan then in the end if the faculty we are working with takes a glance at the patient and does not agree with what the patient and the student have come up with then the entire process gets halted. The patient should make the final decision, but many times they do not feel they are in a position of power so they will yield to the faculty’s decision. The best advice I can give is to stick with the same faculty (especially in complex cases) and empower our patients to let them know they have the final say. The patient’s decision trumps all, in the end it is their mouth and their choice.