114 - A debatable lack of interest

Mr X visited Dr A for many years. He had poor oral hygiene and generally did not respond to advice. Mr X moved from the area and was seen by Dr B who advised him that he had severe periodontal disease and recommended eight extractions. The proposed remedial treatment plan was both extensive and expensive. The patient subsequently sued Dr A for failure to diagnose periodontal disease and for failing to offer the treatment recommended by Dr B (which included implants).

The case was successfully defended because Dr A had offered treatment for periodontal disease a number of years previously which the patient had declined. However, Dr A was criticised for not offering the patient alternatives on the basis that Dr A had earlier taken a decision that the patient was not interested in saving his teeth.

It is difficult for any healthcare professional to deal with a non-compliant patient. It is easy in those circumstances to make incorrect assumptions about someone's ability to pay or their motivation for treatment. Such decisions are likely to be viewed by Courts of Law as unnecessarily paternalistic, thereby failing to take into account the views of the patient. It is always best to seek patient views on all occasions and to fully document them in the patient record.