Principle One

Put patient's interests first

 

Principle Two

Communicate effectively with patients

 

Principle Three

Obtain valid consent

 

Principle Four

Maintain and protect patients' information

 

Principle Five

Have a clear and effective complaints procedure

 

Principle Six

Work with colleagues in a way that is in patients' best interests

 

Principle Seven

Maintain, develop and work within your professional knowledge and skills

 

Principle Eight

Raise concerns if patients are at risk

 

Principle Nine

Make sure your personal behaviour maintains patients' confidence in you and the dental profession

 

Learning Material Case Study

Failing to obtain consent Failing to obtain consent

Mrs Wilson went to see her dentist, Mr Harris, as she had a chip at the bottom of one of her front teeth and she wanted it filled.

Mr Harris said that he could provide a white filling on a private basis at a cost of £80 and asked whether Mrs Wilson would like it done immediately. Mrs Wilson agreed and so Mr Harris carried out the treatment.

When Mrs Wilson went to reception to pay, she was charged £120. When she questioned the amount, she was told that was the price that had been written in her notes. Mrs Wilson thought she may have misheard Mr Harris and so she paid the £120.

Two days later, whilst eating her lunch, the filling fell out. She went back to see Mr Harris and asked for the filling to be redone. He said he could redo the filling but it would cost her another £120. He said that he warned her when he did the filling that it may not last for very long. Mrs Wilson questioned why she had been asked to pay £120 for the first filling rather than £80 and why she should pay again after only two days. Mr Harris said it was clear from her notes that he had told her the filling would cost £120. Mrs Wilson then left the practice.

She decided to write a letter of complaint to the GDC. In her letter she said that Mr Harris had misinformed her about the cost of her treatment and that at no point during the initial appointment did Mr Harris tell her that the filling was unlikely to stay in place for long, nor did he offer any advice on how to prevent the filling from falling out.

The fitness to practise caseworker considered that Mr Harris may have breached a number of the standards and guidance in Standards for the Dental Team including (but not limited to):

  • 3.1 You must obtain valid consent before starting treatment, explaining all the relevant options and the possible costs.
  • 3.1.3 You should find out what your patients want to know as well as what you think they need to know. Things that patients might want to know include:
    • options for treatment, the risks and the potential benefits;
    • why you think a particular treatment is necessary and appropriate for them;
    • the consequences, risks and benefits of the treatment you propose;
    • the likely prognosis;
    • your recommended option;
    • the cost of the proposed treatment;
    • what might happen if the proposed treatment is carried out; and
    • whether the treatment is guaranteed, how long it is guaranteed for and any exclusions that apply.

The case was referred to the Investigating Committee. The committee thought there had been a failure in communication. It also thought Mr Harris may not have obtained Mrs Wilson’s consent as the costs were not clearly explained to her, nor was she advised of the risks associated with the filling. The committee decided to issue Mr Harris with a letter of advice reminding him of the importance of providing patients with clear information on costs and risks associated with treatment.

​​​Although Mr Harris made a note of the treatment cost in Mrs Wilson’s records she maintained that she did not know the treatment would cost £120. If Mr Harris had provided Mrs Wilson with a written treatment plan, then it would have been clear to her how much the treatment was going to cost. You must discuss treatment options and costs with patients before formalising your discussions in a written treatment plan. You should also include as much information in your notes about those discussions as possible.