Professional Conduct, Ethics, Records, and Patient Rights
Consent as a process
Informed consent requires discussion of diagnosis, proposed treatment, material risks, alternatives including no treatment, and the likely consequences of refusal, documented contemporaneously. A signature without conversation is not consent. Minors and patients without capacity consent through a parent or legally authorized representative, and consent for expanded or changed treatment must be renewed. Informed refusal deserves the same documentation.
Records and access
Records must be legible, dated, authenticated, and complete enough to let another clinician continue care. Patients have a right to copies of their records; a practice may charge a reasonable copying fee but generally may not withhold records to collect an unpaid balance. Amendments should be added as dated addenda - never by altering the original, which invites a spoliation allegation.
Boundaries of the relationship
Once accepted, a patient cannot be dropped without notice. Termination requires written notice, a reasonable transition period, emergency coverage, and record transfer; abandoning a patient mid-treatment is a disciplinary matter. Confidentiality continues after death and yields only to authorized release, legal compulsion, or specific statutory reporting - child and elder abuse, certain communicable diseases, and impaired colleagues.
Business conduct
Advertising must be truthful and not misleading; fee splitting and improper referral arrangements are prohibited; testimonials and superlatives are scrutinized.
Worked example
A patient with a balance owed requests radiographs and chart notes for a new dentist. Provide copies within the required timeframe, charge only the permitted fee, and do not condition release on payment of the balance.
Rule of thumb
If it is not in the record, it did not happen - and if it is in the record, it must be honest, dated, and unaltered.