Please help further improve the already high quality care of dental treatment in Ireland.

What makes a good decision?

Communication is the bedrock of good patient outcomes. From that initial meeting at the first clinical examination as a new patient, through to completing treatment – the better the communication, the higher the quality of trust. Trust is built on consent, respect, dignity and understanding. The patient’s capacity for decisions is also central to good communication and trust.

The principle of informed consent is usually considered to be permission granted in full knowledge of possible consequences of treatment with knowledge of the potential risks and benefits. Patient dignity usually refers to treating patients with respect, valuing their individual needs and preferences, and ensuring they feel valued and in control during their care. Capacity is considered to be the patient’s ability to understand when a decision is being made and the nature and consequences of that decision in the context of the available choices.

The dental surgery

In the busy dental practice, the everyday aspects/tenets of communication, consent, dignity and capacity can be seen during every single patient interaction. 

As dentists, we provide interventive treatments, where our patients typically have dental instruments in their mouths – significantly impeding their ability to speak/verbalise their wishes. During training many of us may have learned to say: “Raise your hand if you wish me to stop”. While this is helpful, there is currently no prescribed, verified, authenticated standard or evidenced informed guidance on this non-verbal system.

The research

I am undertaking research as part of a doctoral programme (PhD) at the School of Population Health at the Royal College of Surgeons in Ireland (RCSI). This self-funded and independent research is investigating a simple rudimentary hand-signalling system which will assist both patient and dentist with this missing piece of the ‘communication-consent-dignity’ challenge.

How does could this affect my practice and my patients?

Good communication in healthcare is enshrined in policy (Sláintecare, 2018) and is also found in the  Irish Dental Council’s Code of Ethics: 4.2 Your patient is entitled to refuse treatment. If your patient refuses treatment, you must record your advice and the patient’s refusal to undergo the treatment in the patient’s records. 

Elsewhere, the literature also tells us that impaired communication can erode or impair trust, consent, shared decision making and adversely impact on patient dignity and clinical outcomes (Burt et al., 2014). The dental surgery is at a higher risk of this due to a patient’s inability to answer verbally when instruments (e.g. handpieces) or appliances (e.g. rubber dam) are in place.

Barriers to effective communication are a leading cause of litigation. Negligence cases are less related to the clinical quality of care but rather triggered by inadequate communication (Hegan, 2003).

A solution?

A proposed hand-signalling system with clear actions (e.g. Stop, Proceed, Query, Suction, Rinse) may provide a solution. A short five-minute survey gathering dentists’ views on this important research is accessed via the QR code below or directly by the survey monkey link. We need to know what you think!

A research-based, evidence-informed system of this nature could support consent, dignity and communication during operative procedures. It could also assist with demonstrably showing patient capacity. It could therefore support clinical records, clearly showing a pathway for patients’ decision making and consent – and thereby protecting their dignity. Such a facility would also support the dentist should any issues, queries or complaints arise after treatment.

This is an anonymous survey ( there is no personal data collected – e.g. we are not collecting names, addresses, emails or phone numbers!). It takes just five minutes to complete – less time that it took to read this column! Please help to bring this research to fruition – and further improve the already high quality care of dental treatment in Ireland. Thank you!

Complete the survey online, visit surveymonkey.com.

Thank you for your help. If you have any queries or wish to learn more, please contact me at: paulodwyer@rcsi.com

Tags: patient care, survey