November 1, 2005
by Bruce Glazer
Here I am standing in line at Gallerie Lafayette, one of the largest department stores in Paris, standing in a line that winds endlessly around the exterior of the Louis Vuitton department. I was honouring a birthday promise to my wife, which, included a trip to her favourite city on earth. And of course to go along with the trip, every woman’s dream, a new purse– part of the never ending Paris ‘accoutrements’. But I was a crafty devil, for I knowingly steered her to a department store with a difference — supposedly a 22% discount difference. After showing my passport to customer service I received a coupon for a 10% reduction in the store and Louis Vuitton like many other fashion designers had a physical space within the larger department store. As well, since I was not a resident of France, I would receive an additional 12% detax refund–22% in all. I had been waiting in line one-half hour before being allowed into the Louis Vuitton department. I reasoned that long lines equate to great prices. Once inside my wife struggled to decide which of the unlined beauties would become her birthday gift. Finally Alma was the winner. The clerk wrapped our prize and I reached into my pocket to present the Lafayette 10% discount coupon as the detax was a slam dunk.
“Dsol, monsieur, il n’y a pas de rabais de 10% ici chez Louis Vuitton. On ne fait partie du grand magasin, Gallerie Lafayette.”
The promise lay heavy and having already invested over one hour of our short trip in line I was not prepared to try and uncover a comparable bargain. And so the game began. I could still claim the detax? I bitterly settled the account and purchased several more items in order to take advantage of the minimum purchase necessary for detax eligibility. Shopping complete, we lined up again to gain the refund. Once all the forms were complete and receipts surrendered, the clerk informed me that because Louis Vuitton was not part of Lafayette I could not piggyback any purchases to it.
In Vuitton I was annoyed, but now I was livid and after a few choice remarks to whomever was close at hand I hurried to return everything I had just purchased save the unlined purse. What has this story to do with dentistry or for that matter with informed consent?
Our patients present for consultation with certain expectations (22 % discount) and we are obliged by the Health Care Act 1996 to provide enough information to receive informed consent. In the case of prosthodontics we face a daunting task and we may be falling far short of the mark.
According to the Health Care Consent Act, 1996 the following elements are required for consent to treatment:
* The consent must relate to the treatment.
* The consent must be informed.
* The consent must be given voluntarily.
* The consent must not be obtained through misrepresentation or fraud.
A consent to treatment is informed if before giving it:
a) The patient giving consent received information about the treatment that a reasonable patient in the same circumstances would require to make a decision regarding treatment;
b) All questions regarding treatment received responses.
In order to be informed, the patient must understand the nature of treatment, its benefits, risks, side effects, alternative courses of action and likely consequences of not having treatment. How detailed is your case presentation?
The original salesperson at Lafayette should have explained the lack of cooperation between Vuitton and the department store. Incidentally Printemps, another department store one block away, did explain, right up front, that certain designers did not honour the discount.
As you can see, informed consent for prosthodontic patients is rigorous and certainly not a one fits all scenario (tapes may just not do it). Consent goes even further, implied or express and may involve a team of caregivers. Once entered into, all practitioners are liable for the outcome and possibly for one another. How confident are you in the skills of your team? Sobering facts in the light that prosthodontics is second only to oral surgery in civil and collegial litigation.
I solved my shopping dilemma by switching department stores. What do patients do? For dentists and dental specialists, help is close at hand in Risk Management from organizations like Canadian Dental Protective Association (CDPA), a unique mutual benefit (non insurance) society. As ethical practitioners, we must strive to conform to the letter of the law and provide the best treatment based on a comprehensive examination and scientific evidence. However when problems occur we need to have the opportunity to avail ourselves of objective, non-emotional advice, from individuals with no vested interest in the outcome. Associations like CDPA are there to support us by providing advice from clinically based like-minded colleagues. Through membership in CDPA we support ourselves and our practices in a most effective manner.