Consent, records and communication - do you know the drill?

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Would you recommend discussing finances concurrent to the discussion of each treatment option (along with time and risks involved etc.) or would you leave this until the end (once all options have been listed)?

It is advisable to discuss the costs associated with each treatment when discussing that individual treatment option. In that way the patient is likely to have an increased understanding of all associated factors and make an informed decision. The important issue is that you have discussed the costs, options, risks, benefits etc. and have these documented in your records, thus meeting your obligations to the patient, and to the code of conduct..

I had a patient today that suffers from dementia and refuses to have a carer present, how would you handle that situation? The sister later came in after the patient left the clinic questioning her appointment. I did advise that the sister should be present at all appointment if they are to go through with treatment

The Dental Board code of conduct 3.6 states

Good practice involves:

considering the young person’s capacity for decision-making and consent; in general, where a practitioner judges that a person is of a sufficient age and of sufficient mental and emotional capacity to give consent to a service, then that person should be able to request and provide informed consent to receive services without the consent of a parent, guardian or other legal representative

In light of the code, assuming the sister has appropriate authority, you are perfectly correct in requesting the sister be involved in the decision making around treatment and document accordingly.

There are many different activities that require consent, and any patient is able to withdraw consent at any time. Consider the example of a 5 year old requiring treatment. A parent might consent, but if the child does not consent, then treatment will not progress.

In this situation, there are two consent processes, the right of the patient to consent or not to the sister being present, and the ability (or not) of the patient to consent to treatment. Remember that the patient has the right to refuse to consent to have the sister present. In this situation, where the patient is unable to consent to treatment due to lack of comprehension, then you would seek consent from the patient to discuss with the sister at another time. If this is refused, then you are unable to gain consent, and you would not continue with treatment.

What about different cultures - language used/type of presentations and how they describe?

This can indeed be challenging for practitioners. Again, we take heed of the Dental Board code of conduct 3.3 Effective communication:

becoming familiar with, and using whenever necessary, qualified language interpreters or cultural interpreters to help meet the communication needs of patients or clients, including those who require assistance because of their English skills, or because they are speech or hearing impaired (wherever possible, practitioners should use trained translators and interpreters rather than family members or other staff)
when using interpreters:

taking reasonable steps to ensure that the interpreter is competent to work as an interpreter in the relevant context
taking reasonable steps to ensure that the interpreter is not in a relationship with the patient or client that may impair the interpreter’s judgement
taking reasonable steps to ensure that the interpreter will keep confidential the existence and content of the service provided to the patient or client
taking reasonable steps to ensure that the interpreter is aware of any other relevant provisions of this code
obtaining informed consent from the patient or client to use the selected interpreter

During the COVID19 times do we need to write the notes that we triaged the patient for COVID, asked them to use hand sanitizer and use pre rinse for every patient?

Yes. As with any assessment, examination or pre treatment regime, you should follow best practice, government health or your professional association directives. Writing a summary in your notes is a contemporaneous record of your appropriate treatment which if done properly will stand up to any scrutiny.