ERGONOMICS // continued from previous


purchasing well-designed loupes that will support you in your best working posture. f


BETHANY VA- LACHI, PT, MS, CEAS is a physical therapist, dental ergonomic consul- tant, international lecturer and author. Bethany is CEO of Posturedontics®, a


company that provides research-based dental ergonomic education and is clinical instructor of ergonomics at OHSU School of Dentistry in Portland, Ore. She covers these topics and much more in her book, Practice Dentistry Pain-Free: Evidence-based Strategies to Prevent Pain and Extend Your Career available through www.posture- dontics.com or by calling 503-291-5121. She welcomes comments and may be reached at valachi@posturedontics.com.


REFERENCES


1) Spear F. One clinician’s journey through the use of magnification in dentistry. Advanced Esthetics and Interdis- ciplinary Dentistry 2006; 2(4):30-33.


2) Branson BG, Bray KK, Gadbury-Amyot C, Holt LA, Keselyak NT et al. Effect of magnification lenses on student operator posture. J Dent Educ. 2004;68(3):384-9.


3) Ariens G, Bongers P, Douwes M, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Oc- cup Environ Med 2001; 58:200-207.


4) Marklin RW, Cherney K. Working Pos- tures of dentists and dental hygienists. CDA J 2005; 33(2):133-6.


5) Lehto TU, Helenius HY, Alaranta HT. Musculoskeletal symptoms of dentists assessed by a multidisciplinary ap- proach. Community Dent Oral Epidemiol 1991;19:38-44.


6) Rundcrantz B, Johnsson B, Moritz U. Cervical pain and discomfort among dentists. Epidemiological, clinical and therapeutic aspects. Swed Dent J 1990;14:71-80.


7) Chang BJ. Ergonomic Benefits of Surgical Telescope Systems: Selection Guidelines. CDA J 2002; 30(2)161-9.


8) Cailliet R. Neck and Arm Pain. 3rd ed. Philadelphia: F.A. Davis; 1991:74-75.


9) Rucker L, Beattie C, McGregor C, Sunell S, Ito Y. Declination angle and its role in selecting surgical telescopes. J Am Dent Assoc 1999; 130:1096-100.


10) Valachi B. Vision Quest: Finding your best working distance when using loupes. Dental Practice Report 2006; 4:49-50.


Informed Consent If it’s not charted, it wasn’t given


by ALVIN WOLFF JR. M


y dentist is like Mary Poppins—she’s practi- cally perfect in every way. There is televi-


sion, there is music, there is nitrous oxide gas and anything else that I may need to forget that I’m at the dentist—when there’s suction down my throat and 10 fingers in my mouth, with a few tools to boot. But many people going to the dentist don’t look forward the visit. Some folks may have unpleasant experiences from childhood, some people have low pain thresholds and some patients only go when something is wrong.


Whatever the patient’s disposition, whatever the treatment, Missouri law requires informed consent. In Missouri the law is that consent must be given and that consent may be oral or written. The ADA has an entire pamphlet on dental re- cords and an extensive discussion about informed consent. The ADA advises that written consent should be given in many types of procedures; difficult or extensive. Consent needs to include treatment options, ramifications of no treatment, alternative treatments, potential complications of treatment, and finally, the patient’s consent.


I recently tried a case in Jefferson County. Hills- boro, Mo. is a typical small town. It is politically conservative. My client was a young woman with eight natural teeth remaining. Her claim is that she went into a dental office with just two teeth that needed extraction. She said the dentist pulled all eight remaining teeth. She said the dentist only had consent to pull two teeth. The dentist said he had consent to pull all eight teeth. The dental office policy was that all extractions were required to have a consent form signed by the patient. There was no consent form signed. Experts for both sides said that there needed to be consent given. The patient’s chart had no mention of consent being given. The jury found for the patient and awarded a verdict for money damages.


One takeaway from the trial is that there were charts from four other dental offices entered


24 focus | JUL/AUG 2013 | ISSUE 4


into evidence. These were charts outlining the patient’s previous dental care from having previ- ous extractions to having dentures made. Not one of the other charts mentioned consent for any of the procedures! Luckily, the patient was always happy with her care at the other dental offices, but if she has been unhappy, she could have made something out of the situation because consent was not documented in the chart.


From a plaintiff’s lawyer’s perspective here’s my advice: If you have an office policy in your practice requiring written consent, follow it. If you have an office policy in your practice requiring oral consent or adequate consent, document it. Put- ting into the file “treatment options explained to patient, risks discussed, payment discussed, patient consents to treatment plan of … ” you will have an argument that, while it may not keep you out of court if something goes wrong, it will go a long way in having the jury side with you. A well-documented consent in the chart will leave the patient having a tough time finding a lawyer for an informed consent case.


My dad practiced law for 58 years. He would say “It’s better to have a fence at the top of the hill than an ambulance in the valley below.” Put a fence around your chart by documenting consent each and every time. It’s worth it and it can save you from stress, distress and problems with the dental board or the courts later on.


Remember, people who come into your office are from all walks of life. They may be medicated, they may be sue crazy … they may even be the perfect patient. One thing is certain: You never know a patient is going to turn on you until it happens. Protect yourself; document your file. Mary Poppins documents consent in her charts and so should you. f


ALVIN WOLFF JR. is an attorney practicing at the Law Office of Alvin Wolff Jr. and Associates in St. Louis, Mo. This article does not constitute any endorsement by the MDA of this firm or its attorneys; it is being provided for information only. Members are encouraged to contact their legal counsel for specific questions.


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