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Refusal forms

The new office I work for has refusal forms for everything. X-rays, perio chart, SRP, etc. To me this supervised neglect for over 2 years of X-rays and 1 year for perio chart. I’m not sure about the SRP. I had one pt who had not had a perio chart in several years due to refusal. I explained to the pt why it was so important and she allowed me to chart. I know the pt has a right to refuse tx but diagnostic tools. How does that work for SRP? Is the office legally covered with signed forms? Does anyone else have an office that does that?



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1 Answer

According to the ADA, the office is not legally covered with signed refusal forms: “If the patient refuses the proposed treatment, the dentist must inform the patient about the consequences of not accepting the treatment and get a signed informed refusal. However, obtaining an informed refusal does not release the dentist from the responsibility of providing a standard of care. If, for example, the patient refuses to have radiographs taken, the dentist should refer the patient to another dentist when the original dentist believes that radiographs are a necessary prerequisite to proper care in that case.” This is stated on page 16 of http://laneykay.com/dentalpractice_dental_records.pdf. What this is basically saying is that refusal forms are something to be used, until it gets to a point of not providing the standard of care. For example, a high caries risk patient refusing radiographs should be signing a refusal form each time they refuse, but once it hits two years, it may be time to refer the patient to a different dentist, according to the ADA.
 
As far as a patient refusing SRPs, I’ve read articles that suggest doing the less ideal treatment and do a debridement. I’m not exactly on-board with this recommendation because the debridement code definition clearly states that it is to be used for patients that have so much debris, a doctor cannot do a proper exam, so I feel this is a misuse of this code. Misuse of codes can lead to insurance fraud. I worked for a doctor once that after so many times of a patient refusing perio treatment (or radiographs), he would refer the patient to a different doctor/dismiss the patient because he simply couldn’t take on the liability to the office or risk his license. This is a tough one because as a clinician it puts you between a rock and a hard place. It feels wrong to not provide needed treatment, but it also seems wrong to dismiss a patient because they can’t afford treatment. There’s just no good answer here, unfortunately.
 
While patients do have the right to refuse treatment and diagnostic tools, practices have an ethical responsibility to abide by the standard of care. We live in a sue-happy society and this could really burn the office!

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