Unit 4: Administrative Operations
Administrative Operations

Section 4. Scheduling

Informed Refusal

If the patient does not agree to the recommended procedure, or refuses the 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.

Numerous malpractice lawsuits have been filed against health professionals by patients who claimed that, upon suffering a serious injury after refusing care, they did not fully understand the potential consequences of such refusal. Coupled with this allegation is the assertion by the patient that he or she would have consented to the procedure or treatment if only the risks of refusal had been properly and completely explained by the health professional.

Documenting that the patient refused care after being informed of the risks requires efforts beyond the normal informed consent documentation.

Although following these risk-management guidelines will not guarantee that you will never be sued for failure to properly inform a patient of the risks of refusing care, the quality and quantity of your documentation will strengthen your defense of these claims.

Tips on Handling the Informed Refusal Process

  • If the patient refuses the recommended care, 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 the procedure or treatment, emphasizing the probable consequences of the refusal.
  • Use of audiovisuals such as brochures, dental models, videos or flip charts may be helpful.
  • Document that the patient has refused the recommended care, the patient’s reasons for refusal, that consequences of refusal were re-explained in terms the patient said he or she understood, and that the patient still refused the recommended treatment. Emphasize that the patient understood the risks of refusing care.
  • Try to obtain the patient’s signature on the informed consent form or in the chart attesting to the fact that he or she was fully aware of the risks and refused the care.
  • If the patient is uncooperative, the signature or initials of a witness to this discussion and refusal should be entered in the patient’s chart or on the form as an alternative.