Here's the problem:
Informed consent only keeps us out of trouble if the patient really understands it and keeps it in mind before, during and after treatment. Written consent and a few droned words aren't enough.
What's the solution?
Obviously, the most important aspect of informed consent is what we tell patients before treatment. But keeping patient in the loop during treatment is a close second. What patients hear repeatedly sticks in their mind. So by giving patients periodic updates on how the treatment is going, we reinforce and clarify the realities they may face.
This completely eliminates the possibility of surprising patients and surprised patients are the ones that leave our practice, write bad reviews and contact lawyers.
Before treatment, we tell the patient that the cavity is deep and root canal treatment may be needed. During caries excavation, we say:
"Mary, as I predicted, the cavity is very deep. We still have a chance of not needing the root canal, but it can go either way. Keep your fingers crossed."
Before treatment, we tell the patient that the root has filled in with minerals and the root canal may not be possible. While trying to access the canal, we say:
"John, as we discussed, your root has filled in with minerals and so far I haven't been able to get into the area we need to treat. Unless I can do that, we won't be able to do the root canal and we'll have to plan on taking out the tooth and doing an implant. I'll do my very best to keep that from happening, but it may not be possible."
When patients feel included in their treatment, even if the outcome isn't what they would have liked, they never get upset at you.