Treatment Planning Process cont. Flashcards
4 Aspects of Health Belief Model:
- Perceived susceptibility
- px should understand and accept diagnosis of dentist
- dentist must be competent during the oral examination - Perceived severity
- significant for px who is asymptomatic and unaware of dental problems
- px should acknowledge level of severity in their oral condition
- dentist must explain possible consequences if px chooses not to be treated - Perceived benefits
- px should believe that proposed tx plan will solve their dental problem
- photographs of completed case can be a helpful adjunct - Perceived barriers
- vital to convince px that accepting tx is better than living with dental problem
- most common barrier: cost, time, fear of pain
4 Components of Informed Consent:
3CD
- Capacity or ability to make a decision
- Comprehension of the relevant information by the px
- Consent must be given voluntarily without coercion or duress
- Disclosure of all relevant information about the procedure by the health care provider
Informed consent cannot be acquired in the ff. instances:
- Px is in acute pain - unable to voice out concerns or ask questions
- Px is highly anxious - incapable of grasping the proposed choices
- After px has been sedated for injury - cannot use clear reasoning to make a decision at that time
Changes in cognitive capacity may be related with:
- Injury
- Medication
- Anxiety
- Illness
- Degenerative conditions
Relevant Information:
- Nature of the condition or disease being treated
- Proposed treatment
- Purpose and benefits of proposed treatment
- Risks involved in undergoing the proposed treatment
- Potential complication of the proposed treatment
- Anticipated consequences of not undergoing the proposed treatment
- Alternative procedures
- Prognosis of the treatment
Documentation of Treatment Plan:
- Simple documents - pxs who only need 1-2 procedures wherein short entry in the record can convey adequate info
- Complex documents - pxs with several tx options wherein dentist may choose to provide hard copies of multiple tx plan which can be reviewed later
Types of Treatment Plans:
- Active treatment plan - a list of disease control and definitive procedures that are sequenced in order with which they will be provided
- Perpetual treatment plan - deals with px’s needs, concerns, and issues; includes systemic and maintenance procedures
Principles of Bioethics:
- duty to treat px according to their desires (within the bounds of accepted tx and to protect px’s confidentiality)
- basis for the practice of “informed consent”
PRINCIPLE OF AUTONOMY
Principles of Bioethics:
- denotes the obligation to not intentionally inflict harm (pertaining to the acts of commission of omission)
- asserts the need for professional competence
- remains constant
PRINCIPLE OF NONMALEFICENCE
Principles of Bioethics:
- implies the duty to maximize the px’s welfare at all times
- acting in px’s best interest or welfare
- beneficence is a limited duty (since practitioners cannot treat two patients at a time)
PRINCIPLE OF BENEFICENCE
Principles of Bioethics:
- signifies the obligation to be fair in dealing with pxs, colleagues, and the society
- forbids discrimination against an individual or group
- stresses that all members of society must have access to health services
PRINCIPLE OF JUSTICE
Principles of Bioethics:
- involves maintaining honesty and truthfulness in all professional interactions
- basis of trust in the professional-patient relationship
PRINCIPLE OF VERACITY
5 Exceptions to the Duty of Confidentiality:
5Cs
- Consent - px agrees to the disclosure of info
- Court order - release of info is required upon the receipt of an order by a court of competent jurisdiction which must be issued by a judge
- Continued treatment - for the continued treatment of the patient
- Comply with the law - mandatory reporting statutes such as child abuse, law enforcement, administrative agencies, and other lawful purposes
- Communicate a threat - involves the duty to protect others from violence by a patient
How to DEAL with Potential Confidentiality Issues:
Duty - determine if there is a duty to maintain confidentiality in the context of a tx relationship or other reasons
Exception - utilizing the 5Cs as a guide
Ask - consider asking for help from a colleague, risk manager, or lawyer
Law - be familiar with the law of jurisdiction and the confidentiality policy of the health care facility or organization
Accepting Patients into Dental Practice:
- Consider the principle of justice
- emphasizes that dentists’ primary obligations include justly dealing with all individuals and rendering dental service without prejudice - Denying treatment to new pxs is a common form of human rights violation
Can decline treatment for the following pxs:
- Pxs who are extremely litigious
- Pxs with unrealistic and/or impossible expectations
- Pxs who require treatment that is beyond the dentist’s skill or training
Dentist’s consultation with the px should include the following:
- Discussion of proposed treatment
- Discussion of overall prognosis
- One’s ability to provide patient care
When dentist-patient relationships are limited:
- For cases when oral examination are performed to give a second opinion
- For cases when a specialist accepts a referral for a specific procedure
Documentation of termination of dentist-patient relationship:
- Cause/problem that led to the cessation of the dentist-patient relationship
e.g.: failure to keep scheduled appointments, inability to fulfill financial agreements, px’s failure to follow previously agreed-on instructions (persistent non-compliance) - Any attempt/s that may have been made to resolve the situation
For cases when tx is suspended or interrupted, letter should be mailed to the px including:
- Intent to terminate the dentist-px relationship
- Facts and any related practice policies
- Access to his/her records
- List of other equally qualified dentists
- Options for the continuity of care
