If a patient refuses recommended treatment, the dentist should make every reasonable effort to document that the patient understands the risks that may arise from such refusal. This is the concept of informed refusal.

Patients have filed malpractice lawsuits against oral health professionals because the patients claim that they did not fully understand the potential consequences of refusing treatment. The patient may assert that he or she would have consented to treatment if the risks of refusal had been properly and completely explained. Following are tips on how to handle the informed refusal process.

• If the patient refuses recommended treatment, ask about the reasons for doing so.
• If the patient states, or if it appears, that the refusal is due to a lack of understanding, re-explain your rationale for recommending the treatment, emphasizing the probable consequences of refusal.
• Use audiovisuals such as brochures, dental models, videotapes, or flip charts.
• Document that the patient has refused recommended treatment, the reasons for refusal, that the consequences of refusal were re-explained in terms the patient says he or she understands, and that the patient still refused recommended treatment. Emphasize that the patient understands the risks of refusing care.
• Try to obtain the patient’s signature on a form attesting to the fact that he or she is aware of the risks of refusing recommended treatment.
• If the patient is uncooperative, the signature or initials of a witness to this discussion and the patient’s refusal should be entered on the form.

BACK

NEXT