Case study: Informed consent in practice

A five-year-old dog was taken to a veterinarian for a general examination and vaccination.

While there, the veterinarian recommended dental treatment, including a dental scale, polish, and examination under sedation. A dental procedure plan was sent to the owner which outlined blood testing, IV fluid therapy, the scale and polish, an oral cavity check and gum probing.

Five days later, the dog was brought back for its examination. The veterinarian discussed the proposed course of action with the owner who then signed a consent form. During the examination, the veterinarian noticed several root pockets and gum recession in the dog. Some of the pockets extended more than 4mm.

The veterinarian called the owner to let them know that their dog would need 11 teeth removed and discussed the treatment plan with them, to which the owner consented. The veterinarian decided not to take x-rays as the root pockets, gum recession and periodontal disease were clear. Shortly after this phone call, the owner tried to call back the veterinarian and the clinic but was unable to contact anyone. They left a voicemail and emailed the clinic.

Eventually, the owner contacted the clinic and asked the veterinarian to stop the dental procedure. The veterinarian explained that the owner had already consented to the procedure, and most of the work had been completed.

After the procedure, the dog was discharged, and the owner was given information on the procedure and aftercare. Three days later, a follow-up appointment was booked.

The owner made a complaint to the Vet Council about the quality of care provided to their dog and the communication of the veterinarian. The owner raised concerns about the need for the dog’s teeth removal, as its last dental exam, scale and polish under general anaesthesia was done two years before. Other concerns raised included whether removing 11 teeth was appropriate and if the right level of informed consent was obtained.

The complaint was referred to the Complaints Assessment Committee (CAC), which is a preliminary screening body that decides what should happen following a complaint. The CAC can conduct a formal investigation and decide what steps, if any, need to be taken to ensure the veterinarian is fit to practise and public interest is protected.

The Code of Professional Conduct requires veterinarians to obtain a client's informed consent before proceeding with a proposed treatment or course of action. This process involves the veterinarian providing information in a way that is understandable and allows the client to choose to follow the recommendations or not. The consent process needs to be adequately documented.

The client relationships part of the Code states that veterinarians must interact with clients in a way that promotes effective communication and trust. This includes listening to clients, respecting their views, responding to concerns, and treating them with courtesy.

When reviewing a complaint, the CAC measures the veterinarian’s conduct against the standard that is expected of a veterinarian practising in similar circumstances, and the expected professional standards.

The CAC felt the veterinarian in this case followed an appropriate process for obtaining informed consent for the initial dental procedure and gaining verbal consent for the extractions. It commented that the consent process had been adequately documented in the dental procedure plan, the client consent form, and the clinical records.

The CAC noted that client expectations can be difficult to manage during dental procedures. Generally, a complete dental examination can only be performed once the dog has been anaesthetised.

It also agreed with the veterinarians’ assessment and decided the extractions were appropriate, especially because the pocket depth was larger than 1mm or 2mm.

The CAC commented that radiographs could be a helpful tool to enhance client understanding. Radiographs can help demonstrate the full clinical picture to the client and confirm the condition of an animal’s teeth. This information can then be provided to the owner to help them understand the level of disease and importance of a procedure.

It was decided that the veterinarian acted in line with the expected standards of the profession and no further action was taken.

The CAC believed that several learnings could be taken from this case and provided educative advice to the veterinarian.

Revisiting the clinic’s client consent form was proposed by the CAC to account for situations where additional extractions or diagnostics may be required, as well as including options for owners if they cannot be contacted. The CAC suggested including wording in the forms to say that the owner will be contacted if extractions are required or if an initial estimate needs to be revisited. The CAC recommended giving owners options to either proceed with the extraction, contact them if the cost of the treatment will exceed a certain amount, or stop the procedure if they can’t be reached.

The veterinarian implemented these changes. The documentation for a dental treatment plan was amended to add a clause offering a referral to a dental specialist as an alternative option. The standard admission process was also changed to include a discussion regarding a client’s financial limits and confirming the contact details of the person who can make decisions on the day of the procedure.

The veterinarian also ran a clinic-wide training session on improvements in dentistry and dental radiography.

Veterinarians may find it useful to refer to the Vet Council’s guidance on informed consent here.