Consent Is Like An Onion – Are You Consenting Your Patients Correctly? – PDP113

Jaz’s Introduction:
Consent is like an onion. What does that even mean? Well, you have to listen towards the end of the episode to find out what I meant by consent is like an onion. Now this episode is going to go in the Protrusive Hall of Fame like think of episode 10. I always refer back to Episode 10 with Zak Kara because I know how much you guys loved it because the stats always show me that people are listening to that one again and again and again. That’s probably the most repeat listen-to episode there is and I’ve got a funny feeling that this episode is going to actually surpass that as the most listened-to and repeat-listened-to. And I even I can’t wait to listen to it again. Because there are so many great non clinical communication gems, which I know we all crave. Protruserati, Welcome back to the Protrusive Dental Podcast. I’m your host, Jaz Gulati. I’ve got Shaun Sellars and Zak Kara on today. And this is gonna blow your mind. Some of the laws that we discussed in terms of consenting are specific to the UK. But if you’re in the US, Australia or around the world, we all consent our patients and you will definitely take away some very tangible points on how to be an effective communicator and consent your patients properly and that does not mean you tell them every single damn option. You’ll find out why when Listen. This episode is brought to you by enlightened smiles. This is the premium brand of teeth whitening. They guarantee a B1 shade and it’s just a slick system. The branding is on point, the passing on point, patients love it very low sensitivity from my experiences. And so the reason this is relevant to consent is I did their online training some years ago with Payman Langroudi and it’s brilliant. It covers so many points related to consenting our patients probably for teeth whitening from the white patches that can arise, from the expectations of result for the treatment durations, for different cases, for example, tetracycline staining, they have the whole protocol. So do check out their online training. The link for that is protrusive.co.uk/enlighten. And that will take you straight to the page to book onto the online training. I want to thank Enlighten smiles and Payman Langroudi for supporting this podcast. The Protrusive Dental Pearl for you is a gift. It’s a PDF gift to you which Sean Sellars actually made. It’s the flowchart for consent which we discuss in this episode. So if you want to access that make sure you are subscribed to my email newsletter. You can do that by going to protrusive.co.uk/emails and if you’re listening to this episode in the future, you will find that email because I’ll make it public and you’ll be able to download that PDF. Now just before we join Sean and Zak for a fun chat let’s take a moment to reflect and also say Thank you. Okay, so I’m gonna start with thanks first. Yesterday it was announced that I’ve been voted amongst from all you guys, all the peers as a top 50 dentist. Now what that means is like the top 50 Most Influential dentists in the country I guess because it’s a UK thing, dentistry.co.uk. So firstly, thank you for voting for me. I mean, I really appreciate it I never asked anyone to vote for me I kind of have kept quite low key about this. So it’s very sweet of you guys to get up your time and vote Wow. I mean, thank you really from the buttom of my heart for doing that. But if I was to go a bit reflective for the reason I did and promote it as much as perhaps the people who make these things wanted me to is one main reason I’m gonna read you a quote. Okay, let me read you a quote. It’s a quote from Adam Grant. Okay? It says this, he says this. “Beware of confusing attention with admiration. Being noticed (ie through a platform such as a top 50 voting popularity contest) Being noticed, isn’t a substitute for being respected. Don’t mistake recognition for appreciation. Knowing who you are, doesn’t mean people will value what you do. The point of sharing isn’t to gain followers. It’s to make a contribution” And say again, it’s to make a contribution. And the reason I reflected in this way is that whilst I’m so thankful for you guys voting for me, I mean, that’s really kind. And thankfully, when I look at that list of top 50 There’s so many dentists, there’s one of my mentors, Riaz Yar, he contributed so much to occlusion. He’s doing studies with dahl and it’s just amazing. There’s too many to name from Tif Qureshi, and I’m not gonna name any more because I’ll get in trouble for missing people that there’s so many great dentists, Raj Ratan and another one that comes to mind in terms of great contributions in dentistry, but remember that there are the unsung heroes in dentistry who makes so much of a contribution that aren’t recognized in this somewhat of a popularity contest, I’m sorry if that offends anyone. So let’s take a moment to think not about the top 50. Let’s think about all the people in your life, you as a dentist, think of the person who has made a contribution to you in the last year, and I want to message or email, this dentist or colleague, or coach or whoever it is, and say, Listen, you might not be in a top 50 list this year. But that doesn’t mean anything to me, because you have made a huge contribution to my professional development. And I think it’s a great thing to be able to thank the people around us who helped us so much. Anyway, I am so pumped for you to listen to this, check it out. And I’ll catch you in the outro.

Main Interview:

[Zak]
I will try to consent that person. But actually you can come across as you’ve kind of not quite planned ahead. So careful.

[Jaz]
Yeah. But I think the crux of it is sometimes to ask questions to validate their understanding, I think is a good way to do it in certain procedures. Which leads me nicely to consenting patients. And, Shaun, there’s something that I know you’re quite hot on, you’ve got this PDF that you sent me, is that something that you’re hoping to share with us?

[Shaun]
Yeah, absolutely. So for one of my assignments, in my master’s, I came up with this workflow on consent. So everyone gets worked up about consent. And with some of the changes in the law fairly recently, the way that we have to present complex consent to patients is confusing to a lot of people, I think. So my little workflow, which there’s a copy here

[Jaz]
I just forwarded it to you, Zak. So I mean, essentially what you’ve made, just describe to listeners, what you’ve made here, we’ve got workflow.

[Shaun]
So we’ve got the number of sections on the process of gaining consent, most of it’s where we’re quite good at but one of the difficulties that dentists find and healthcare workers find is this idea of balancing risks and benefits of treatment to patients, how do we do that in a way where we can ensure that we are getting pretty solid consent at the end of the day. And that changed to a certain extent in the Montgomery ruling, which some of you may have heard of. Although if we’re being technical, all Montgomery did was change the law to match the guidance from the GDC and the GMC. So we should have been doing this for a number of years already, theoretically.

[Jaz]
Can you show for those young dentists who may have not attended the law and ethics lectures at dental school, just briefly explain the ramifications of Montgomery. And if you were to do like a one paragraph summary of what we need to do in our practice now to make sure that we are consenting effectively, what would that be?

[Shaun]
Okay, so before Montgomery, the amount of information you needed to disclose to patients on the risks and benefits of a treatment was governed by what an average dentist would give to patients. And that sort of ruling was based on the Bolin case in the 50s. So we were consenting to a level that was acceptable in the 1950s, which probably isn’t right. Admittedly, the sidaway Casio came from his 80s. But still, we’ve changed a lot. Our laws are based on our ethical backgrounds and the way that society accepts things, okay? So Montgomery has changed that. So what Montgomery says is that the information that you need to give to patients on the risks and benefits of treatment should be based on what that patient in your chair considers to be important and relevance, as well as what dentists think is important and relevant. So it’s a different level of information disclosure, what it doesn’t mean is you have to tell patients about every single thing that could possibly go wrong with your treatment. It doesn’t mean that…

[Jaz]
Which is what some consent forms do.

[Shaun]
Absolutely. And to be perfectly honest, most consent forms aren’t worth the paper they’re written on.

[Jaz]
Thank goodness, because I don’t do but I should, in the next year or so one of my things in my clinical workflow is to add them because as Lincoln Harris taught me in one episode is that people consume information differently. Some people are good listeners, some people retain more when they’re reading things. So it’s good to cater for all types of people. But do you use consent forms? Both of you, Shaun, Zak, do you have consent forms? If so, how do you implement them before we then go deeper into the topic of consent?

[Shaun]
So very briefly, yes, we get people to sign on a clear path and give them a paper copy if they want it.

[Zak]
We do a similar sort of thing. We sign off an estimate for certain types of treatments. The main thing that I’ve been involved in, I think I’m gonna pause this, I’m gonna pause mine and I’m going to tell you, I’m going to ask you when I present you with an ‘Am I naughty if’ later

[Jaz]
Okay, fine, awesome, awesome, we will do that fine. So fine, you’re still using Form stuff. So you mentioned that really well, you describe Montgomery perfectly. So going back to your workflow, you’ve understood the patient, and you’ve given them the reasonable risks that you feel they need to know. And then therefore, as part of your very top of your flowchart, reasonable treatment options, and then you split that into three. So I’ll let you take over again, you’ll do a much better job than I

[Shaun]
So the first and most basic thing is to understand what your patient wants out of the treatment. Okay, so there’s, if you’re patient has come to you, and has constantly for years and years and years said, the last thing I ever want in my mouth is a denture, okay, and they’ve got a couple of edentulous spaces, say they need to replace a couple of premolars, you might want to mention a denture in passing, but you don’t want to spend a lot of time on it necessarily, because they don’t want it. But when you’re presenting your treatment options to patients, so replacing missing teeth, do nothing denture bridge implant, this is classic, okay, how to replace a missing tooth writing consent. Do nothing is always an option. So you must, must, must, must, must always say you doing nothing is not, even if your pain the patient comes in massive amounts of pain, do nothing is an option. You can say it’s not a good option. And you should be able to recommend a treatment option. If you look at the law, if you look at all the guidelines

[Jaz]
Which is something people forget, you know, there are people Yeah, we can, should recommend something people often just splattering out eight different options getting, you know, getting patients to pick like some sort of like a gamble, recommended because

[Shaun]
He’s the expert in that room.

[Zak]
And they’ll get what would you do? And they’ll go Oh, no, I can’t tell you that.

[Shaun]
So the way that I get around that is I would choose this, but I am not you so you kind of get the best of both worlds. You can say, look, it’s your decision, you do what you like, but I would do this, and this is why I would do this. So you give you get again, you’ve got that story to give.

[Jaz]
Because X, Y and Z is important to me. That’s I mean, yeah, the whole thing in medicine, okay, I’ll like you to take on that because I like where this is going.

[Shaun]
So then legally and according to the guidelines, you then have to present the risks and benefits of those treatment options equally. So in, so say, okay, she’s having treatment routine is gonna get out of pain, but it may fail, you know, 80% success rate in practice, 90% success rate in practice, or you could go see a specialist, and you go through your treatment options. Even handedly given these these risks and benefits of the treatment, then you enter this sort of dialogue phase. So you have to sort of have a bit of chat with your patient. And this is where, again, understanding your patient really comes into its own because some patients will not want to know a great deal about the treatment, they just say, What would you do, I’m going to get on and do that. Fine. Some patients will want to go that I really don’t know, I need to go and think about this, I need to go and talk to my other half about this, I need to consider this, this this and the cost nor the NS it. And if you look at all the guidelines, one of the things that is really, really clear is that patients need to be given time to consider their choices. So I had a patient, when I was working in Lincoln, he went down to a large practice in the south of England. I don’t know where. But he had a completely failing dentition. He was considering implants. I wanted to refer him to Collin but he didn’t want to pay Collin’s prices, fine. No problem at all. Went down, found a practice that would do it. He came back to me and said I went to that practice and they they did an assessment for me and said, Well, we can do it this afternoon. We can do your. And that he just went no, I’m not I’m not doing it. But the consent process of that practice must have been awful, because how can you consent to a procedure that is so invasive, expensive and potentially unpredictable? Because I knew that the chap’s history, in a couple of hours, you just can’t do it. So your patient has to be given time, and then they’ll come back. And you can say right. So that is a problem in practice, actually giving patients that time to think about things is an issue because you want to be booking that patient into the treatment. So the way that I do it is I can paste in my card. I say that this is these are the pros and cons. we’ve chatted about that. Here’s my card. There’s the practice phone number on there. There’s my work email address on that. If you’ve got any questions, give us a ring, drop us an email. What I will do is I will follow up with an email with some information on, so then I will, either sit down and write them an email, which you can do in your own time, which is quite nice or, again, plug for pro has lesser letters to write to patients and what are called reports. So they can, you can essentially template a load of treatments that you’ve done, or you’ve got to do say you want to do an implant for a patient, you can say, what these what implants are these the benefits and risks of implants, and you can email that to the patient, you get read reports. FlyNotes something very similar. This is very good, actually. And you know, they’ve digested it, and they get the chance to reply to the things that have been brought up there. So you’ve got this idea that the patient can sit and think and then contact you to make the appointments as appropriate, I think we get hung up about patients making the appointment there and then because they don’t need to, at the end of the day, do they as long as they book in and get the treatment they need.

[Jaz]
That’s fascinating, Shaun because and I totally agree with you, because that is so valid. But I’ve been on few ethical selling courses, let’s call them, communication courses. And you know what they say? It’s like the number one rule of sales, like they can’t leave the practice without booking something, they have to book something in. And you think that is this mad, you know, hack, but this is what they’re, the gurus are teaching young dentists who,

[Zak]
From practice efficiency for creating workflows, it can be one of the simplest things because then you know that person’s in your diary. But you shouldn’t be putting them in your diary just for funsies. Just because you it’s in your benefit and not there benefit. That the thing you should have. And this is one thing I learned through failure, as a young associate in a practice with not very many systems is that you need to have backburner banks of people that you need to follow up, you need to have people that on the other end of the spectrum who actually want to see you sooner, you need to have a list of those people. And so you need to be able to dig into that when you’ve got a short notice last minute cancellation for an emergency tomorrow. So something happened and you’ve now got a two hour empty space in the diary. That’s why those ethical selling type people will say it’s necessary because they want to fill the diary space. But that’s not a bad thing as long as you’re doing it in the right way. Is that fair to say?

[Shaun]
So I’ve got so many points on that. For a start, there is no such thing as ethical selling. There’s no such thing. Does not exist. Does not exist 100%

[Zak]
Can we quote this, because this is the guy

[Shaun]
In absolutely. There are three stages to the consent process, there’s capacity, your patient has to have capacity to consent. There’s the knowledge and information, which is what we’ve just been talking about. But one of the most important stages of the consent process is that it must be done voluntarily without coercion from anyone. And that includes us, ethical selling does not exist. That doesn’t mean we don’t sell. I don’t think we sell treatments. I don’t think we sell treatment at all. We sell ideas. But most importantly, we sell ourselves. We are the products, okay? And the way that we sell ourselves is by making the people in our chairs and the people around us confident that we can carry out that treatment. But ethical selling is bullshit. Now, if you like. And there are people that have made very, very good money out there repeating..

[Zak]
Mantras.

[Shaun]
Yeah, exactly. Do not be taken in by that because people can read through it. If people are saying, Oh, you’ve got to do this, NLP this. It’s utter utter rubbish

[Jaz]
Zak, I know you want to add to that. Because you’re, I mean, I don’t know if you want to reveal this. And you know, you don’t have to, Zak, reveal this if you don’t want to but you sent me a really cool thing that you sent your patients who are thinking of sending your patients as a way of checking the understanding and checking consent. Is that something they want you?

[Zak]
So am I naught if? Sure. Am I naughty if I have completely turned what used to be my consent process upside down by using technology, right? My method with this now is something called a TypeForm. You might have heard of typeforms, which integrates video, audio, pictures, that kind of stuff like animation, you type stuff, and words. And what I did is I told myself, okay, if this is a 21st century, right? If I haven’t already got compacity and voluntariness, by virtue of the fact that this person in front of me is let’s say, consenting for a dental implant or something more complex like orthodontic treatment, something significant then I don’t have a paper based form anymore. I have an online type form. And it’s a method of gathering that person’s understanding progressively through this. But also checking, they’ve actually done that thing and watched it because they’re required fields. And you can, by virtue of having done it several times, I now know that it takes at least 15 minutes. So you can’t possibly get through that process if it comes up and says for type form was completed in two minutes. Cut Yeah, I need to reconsent that person because it didn’t happen. Am I naughty? Is that naughty?

[Shaun]
I think I quite like that. There’s a couple of points I would say about that. In my patient cohort, it wouldn’t necessarily work because I have a load and load of old ideas that have real issues with any kind of technology. Okay. But I really like the idea, I think, for that tech savvy cohort of patients. That’s brilliant. That’s really, really good.

[Jaz]
I’ve seen it, Shaun. And this is like, I loved it, I thought it was so so detailed, but not overly detailed. It was very visual, it was so easy to follow. And so I’m a big fan of it.

[Zak]
There are also elements where you know, when sometimes you’re trying to consent somebody for something, but because of stuff that’s happened in your day, this goes back to earlier in the conversation, you may not on top form, and you didn’t explain it in the when you look back and you go, Oh, I was alright, but it wasn’t me on my A-game. Well, if I’ve kind of scripted most of this, and I have a short one minute video for this is what root resorption is and how, why you need to know about it, or what the relevance in your case is. But I’ve also then embellished and customized that particular thing for that particular patient. Then my sort of understanding of, see, one of the things I struggle with in dentistry is that there’s no rulebook, we’re all trying to evolve ourselves as human beings every day, and there is no recipe but actually, if you stick to the core values and principles behind why you’re doing it, which is truly because my heart is in trying to make the process better, not because I’m trying to skimp on it, then actually, I don’t know. What is your other point? You’re gonna make it How am I naughty? Trying to justify it here,

[Shaun]
Just from what you’ve said, I also have this real issue. I used to be, I’m beginning to put what I call protocolization that I can’t really sell, it’s having having checklists for things. So the way that, I’m, this is off topic. So the way I look at things, if you’re going on a plane, you are reassured this flying piece of tin is going to stay in the air. Because the pilot and co pilot have walked round on their walk round, they’ve ticked everything off, and everything is safe. We don’t do that in dentistry so much. Because well, I think it’s partly an ego driven thing in that, well, I don’t need a list of things to tick off because it’s all in my head. But heads go wrong all the time you miss things out the amount of times that you’ve forgotten to pick up the bond, but when you’re doing a composite, and this just gives you a nudge and I don’t want that bond. You know, that kind of thing. So I

[Jaz]
Or your nurse skips the etch or forgets the etch you have to write that down

[Shaun]
Yeah, exactly. So yeah, it works both ways. So I was a few years ago, I was really into right, we need to put protocols into everything, everything, everything, everything, everything. I think there’s still a real place for that getting protocols for checkups, getting examinations, getting protocols for doing composites, getting protocols for doing this and then actually documenting that well in your notes. So you can change the protocols all the time. Because just because you’ve got a way of doing things, doesn’t mean that’s the set where you’re going to do things forever. It has to constantly be reviewed and changed if needed. I’ve completely forgotten where I was going.

[Zak]
Can I just? I was gonna jump in and ask another naughty Am I naughty? Because this is the other thing that I do we have a perio protocol in our practice. Am I naughty if I simply quote the protocol in my notes? Treatment recommended protocol for periodontal treatment grades.

[Shaun]
I think you’re okay as long as you’ve got these. Yeah, as long as this

[Zak]
so that the end, one for that.

[Shaun]
So what you need to do as long as your protocol is dated. So if it changes, it’s been updated. So if you’ve got a, say for example, in at the moment, with COVID that’s going on. We have we’ve got our SOP that was a specific practice sop it currently runs to about 50 pages, because I helped put it together therefore it’s quite intense. And being the tech nerd that I am it’s now on version 5.1

[Zak]
I love you, and I’m disgusted with you all at once.

[Shaun]
So in my notes, when we first came back, it was version three, I think 3.0. So in the notes, and I’ve got all of those different updates to the SOP, on my Dropbox in my harddrive. So I referenced the version of the SOP in the notes

[Jaz]
That is so clever.

[Shaun]
So you could theoretically Yeah, as long as you’ve got a store of all the protocols and how they’ve updated over time, I can’t see why you shouldn’t be able to refer to those protocols, as long as you’ve got some reference to the exact protocol that you were referring to. So if it if it’s then changed, you can justify that. So yes, we’ve changed the way that we’re doing things because we’ve got an updated protocol to do things

[Jaz]
That I do the same thing sometimes. I’m naughty if I’m naughty, but for adhesive protocols, sometimes the right standard as adhesive protocol followed, because I’m sick of writing or copying, pasting because if could see a check on my notes, the same protocol we have done. But then I’ve got a protocol somewhere. But I what I’m really going to take away from what you said, Shaun there is if I update it have different versions. So if you go back in my notes, you will see that two years ago, it might have been V1 and a now it could be like V5.1 like surround sound. So yes, that sounds good. I like that. I’m gonna take that. I’m gonna definitely pinch that.

[Shaun]
What else are we talking about? Oh, yes, patients. So patients, so my old dears probably wouldn’t be so hot on the type form, but there’s definitely a subset of patients that would be brilliant for. The other thing that is really important is to remember that consent isn’t a one time issue. Consent is a process, okay? So that chat that I’m having with my patient before they get into the nitty gritty of the appointment. That’s my consent process for that appointment. So you’ve, so they understand the risks and the benefits of the treatment because we’ve talked about that, or we’ve sent them an email or they’ve gone through your your Wizzy videos or whatnot. But you check that on the day as well. Because if there’s anything that they haven’t quite grasped, or you need to clarify, you need to clarify them before you’re halfway taking your tooth out, don’t you really? And remember, patients can withdraw that consent at any time. Although, yeah, there’s going to be times where that’s a bit tricky when you’ve got enough rate that’s half out or you’ve got this tooth that sections or whatnot. So is it naughty? Absolutely not as brilliant, but it just needs a little bit of

[Zak]
care

[Shaun]
like everything else. Yeah, a bit of care and attention. Don’t we all?

[Jaz]
Okay, have you got any more Zak?

[Zak]
Oh no, not on the tip of my tongue.

[Jaz]
Okay, am I naughty if? If for my clear aligner patients in, let’s just call them Invisalign patients because that’s what I use. Let’s be out there. For my Invisalign patients.

[Zak]
Sponsorship

[Jaz]
I will email them each one individually say that their unique thing that’s unique about them their risks, like hey, by the way, Miss Smith, you are at very big risk of black triangles, in particular, and then everyone will get the same video of me talking through the 16 point-thing that you should know before you start Invisalign. So YouTube video, that’s a private link that only my patients can see. And I’ll email them and it goes through generically 16 But in my email, I’d say you should watch this video please watch the video reply back to me. But pay particular attention to points three and point eight because they are most relevant to you. Am I naughty if I do it that way?

[Shaun]
I quite like that

[Zak]
How can you prove they’ve watched it? How can you prove they’ve understood it?

[Jaz]
The reply. Yeah, they understood bit you know, that’s where you’re Typeform, it works better because it has a bit more responsiveness so but here’s my rationale is like me speaking at them for those eight minutes vs me speaking at them at the leisure time while they’re having coffee with me speaking. What they’re Yeah, they’re listening to me

[Zak]
I only been using mine for the last two weeks. And for the using that method, the feedback I’ve had so far was That was awesome. I got to watch it in my own time. I got to share it with share with my partner. We saw the video of my tooth movements before I started, we kind of understood this was the right decision for me. Awesome.

[Shaun]
Yeah, the guy that comes and does implants in our practice, he does a lot of video consults now, but you’ll also record a specific video for the patient and often for me as well, just to say he said like

[Jaz]
LOOM? Using loom?

[Shaun]
Oh, no, I’m using them for some other bits. I’m not sure what he uses actually. Yeah, but he’ll sit down and just go through treatments for patients. Obviously, he’s done. How many of these so he’s just picking these stock phrases to a certain extent but because you’re picking those stock phrases in the specific order and specific need for that patient. It becomes very tailor made and it’s a really good service. So yeah, using that kind of technology is really good. It’s really good.

[Jaz]
Brilliant. Have you heard? Have you guys heard this thing about consent being like an onion?

[Zak]
Why is it always onion to give? Were chopping onions, we’re gardening we’re doing many things. Listen to the podcast and now Jaz is gonna call consent, an onion. Fantastic.

[Jaz]
I like what Shaun, he said it makes you cry. Okay, let me show this one. This is actually from we was winding up here, but because I want one more thing I want to ask you is how use FlyNotes because you mentioned it in briefing, but I want to know more about more about flying notes. But just the last thing about consent. There’s so much more when talking about the but we, Zak, have another podcast recording about equilibration in 11 minutes.

[Zak]
Were talking about consenting stuff.

[Jaz]
Equilibration. Onions, onion, sorry, onions. The way consent is like an onion. This is from Raj Ratan, right? Consent is like an onion because it has many layers, right? So your patient, turning up at the appointment is the initial layer, then your patient having a seat and opening their mouth is another a layer, your patient having signed a consent form is another layer. And then your patient, you telling your patient and reminding them of the risk is yet another layer. So it’s not just one thing. And I really like this onion analogy, because it’s a multi layer. And it’s not just one signature on a piece of paper. It’s not just one type form that you do. It’s those number of things that go together.

[Shaun]
Yeah, I really like that. And I think so. So just to answer that. With, I don’t get particularly concerned about consent, because at the end of the day, if you’ve got the patient on your side, and they know what you’re doing, and you know what you’re doing, it’s very, very rarely going to be a problem. The only time it’s a problem is if you’ve got a disgruntled patient, or you’ve got a vexatious patience, you are never ever going to be able to stop a patient who is deliberately going to complain about you from complaining, that is impossible. You can laminate,

[Jaz]
Veneer patients are crazy.

[Shaun]
But for the vast majority of the patients who sit in your chair, as long as you have a good relationship with them, consent isn’t going to be a huge issue. The other thing is that the reason that we gain consent for patients or we go through the consent process, I should say, is because we are messing around with patients bodies, and patients have a right to know and understand what is going to go on with their bodies that someone else is going to do. That’s the basis of consent. And that’s why consent really has changed over the years because back in the 80s, back in the 50s. It was this very paternalistic view, doctor knows best dentist knows best, open your mouth, get on with it. Society has changed and society has changed for the better, we are much more in control of our own healthcare and our own the treatment that we have. So we should know more about our treatment. If we were in that position, if we’re in the position of a patient, if I was sat in your dental chair, there’ll be a certain amount of information that I would want to know from the dentist carrying out my treatment. So why shouldn’t it be like that for the patient that sat in my chair?

[Zak]
Damn right. It’s all about mutual trust and mutual relationships. It’s all about people. And this is why I love the times that you’ve invited me on your podcast Jaz because communication is everything and everything is communication. That’s just how every aspect of dentistry works, right?

[Jaz]
Which is just at the beginning as Shaun said, you know, this is , it doesn’t matter how good you are with your hand skills, it’s all about, like we said we can how you make people feel and the communication aspect, the non clinical is everything. Shaun, I’m gonna ask you two things now. FlyNotes, just what is FlyNotes, you mentioned it before. I don’t know what flynotes is.

[Shaun]
Flynotes is a digital tool, specifically to gain, can help and gain consent with patients. It’s brilliant. It’s really, really good. Again, it’s a template based system. So you choose the procedure or procedures that you’re doing, you can select the specific risks and benefits of that treatment, edit the text to go along with that, then package it together, email over to the patients, patients can read it. And then you get a link back saying that your patients have received it, a link back saying that your patients have read it and they get the opportunity to sign their consent forms digitally and ask any questions. It’s really good

[Zak]
A fair counterbalance, I really looked into Flynotes. And I didn’t like one aspect of it, which is that, it’s very wordy. It’s all about my words, and there’s no picture element. There’s no video element. There’s no interactive elements. So it’s so difficult for visual learners and for the wordy people.

[Shaun]
So that’s why I tend to use karoku Pro a little bit more where you can add pictures and that kind of thing. I also know that Brian’s dental are about to launch some kinds of similar system I haven’t seen anything about that. But if Connor or any of the Brian people want to hit me up more than welcome to send me a link to have a look at that, that’d be good.

[Jaz]
I’m sure they will. Chaps, it’s has been an absolute pleasure to speak with you both. Shaun, thanks for giving up your time and sharing some of the gems that you learned from your masters also just conversational gems and a little bit about how you speak with your patients which are the real details that are the Protruserati love and they want to know about what are the things that we say which is why Zak is so popular and we always love having you back on Zak and the return of “Am I naughty if?” was very special. Gentlemen, thanks so much. And I look forward to catching you both again soon.

[Zak]
Jaz, one last thing. Shaun needs a plug.

[Jaz]
Of course. Absolutely. Shaun, what are we plugging? Are you have you got of course

[Zak]
No. Podcast. Only so many commutes to work and back. But obviously, the Protruserati know and well that they listen to the Protrusive Dental Podcast but there is also one.

[Jaz]
Incisive Decisive, and it’s great to have you Shaun on our little telegram group as well. And I’m more than happy for you to post your post your episodes on there, man, you know that

[Shaun]
So Incisive Decisive is the original and best dental product on ethics and philosophy. Myself and Colin Campbell, we were on long term hiatus, partly due to COVID. Partly due to me moving but we’ve recorded some. We have recorded some new episodes. We are sporadic at best and trying to get those edited. That’s a long story. Yeah, it’s incisivedecisive.com

[Zak]
I really enjoy it. So jump on that for sure. And the banter that you guys have Colin and you agree

[Shaun]
It’s significantly more swearing.

[Zak]
Scotsman involved, of course.

[Jaz]
Well said, Well, I’ll definitely add the link for those who haven’t listened to Incisive Decisive into new episodes coming. I’ll put that link in the show notes as well. So thank you so much for that. And thank you, Shaun. Appreciate it.

[Shaun]
Thank you very much. Thanks, guys.

Jaz’s Outro:
There we have it guys. Wow, what an episode so many gems, I think you’re gonna have to come back and listen to it again, right? I think it’s one of those where you just kind of like you know, curl up one day in bed and just listen again. And then you listen to again, and this time, you can take notes. And by the way, the transcripts of all the episodes are on the website, so if you ever miss anything, or you want to see exactly what they’re saying, they’re about 99% accurate Okay, so bear with me. I try and do what I can. So don’t hold me accountable for it slight inaccuracies in terms of spellings and stuff. Anyway, hope you enjoy that episode. Thanks so much for listening all the way to the end as you always do. If you found this of value, please share it with a dentist and your practice feature. Please share it with your colleagues. Please share it on social media. Shout about it from the top of the tree tops. I’d say that carefully. And if you’re watching on YouTube, please hit subscribe. And if you’re listening, please consider leaving me a rating. Thanks so much and I’ll catch you in the next episode