Competency and complications
A patient presented with a 25 vertical root fracture and as such, the tooth could not be restored. I discussed all the potential risks with the patient and gave the necessary warnings, and as well as ensuring that the consent process was recorded and documented in my clinical notes.
I assessed this extraction as "difficult" and therefore possibly out of my skill set. But the complexity of a case is not always easily assessable as a new graduate, and I was under pressure from my new practice to fill my appointment book.
In hindsight, the procedure should have been referred immediately. Failing that, I should have requested advice on the x-ray from the more experienced dentist who was just down the corridor.
When I numbed up the patient, the root disappeared into the maxillary sinus. This had been a possibility but I didn’t really think it would happen. I immediately discussed the situation with my more experienced colleague, who instructed me to be fully transparent with the patient (including a thorough apology) and a call to Dental Protection.
The patient was sent to the oral surgeon and dealt with swiftly. Fortunately, the patient was understanding and was looked after well.
The Dentolegal Adviser's perspective
Dr George Lazaridis, Melbourne Office
Do not be embarrassed to say no to a treatment that is outside of your skill set. Patients can pressure us to perform procedures that we are not comfortable carrying out, but the possible complications, subsequent lawyer’s letters, and potential AHPRA submissions following a notification or complaint can be a nightmare.
Ask for advice before treatment to help assess the case, and ensure there is someone to call upon in case a complication does occur. Advising patients of risks and warnings is a must, as is referral when a practitioner is out of their depth.
These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription.
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