The whole truth?

05 June 2020

Patient Ms H contacted the practice of Dr A as a new patient. She wanted to see the hygienist for regular cleaning as she had been used to at her previous practices.

Ms H saw Dr A for an initial assessment. She gave a history of antibiotics for a gum condition and explained that she had a “genetic tendency” and “previous medical issue”, which had predisposed her to bone loss, but this had been dealt with. 

Dr A noted that Ms H’s oral hygiene was poor, with food trapping and mature plaque deposits. To help ensure she understood how best to keep her mouth clean Dr A demonstrated some different types of interdental brushes. 

Ms H said she knew all about interdental brushes: she found them uncomfortable and was not prepared to use them. Dr A moved on to discuss floss, which the patient also dismissed. Ms H declined to have radiographs taken as she did not agree with them; Dr A respected the patient’s wishes on this but explained that radiographs can be helpful in allowing a full assessment to be carried out.

There was some bleeding on probing and a full-mouth periodontal charting was completed. This confirmed widespread pocketing, subgingival calculus and some mobility. Ms H asked Dr A to explain what she had found.

Dr A outlined her findings and also provided advice on the effects that Ms H’s smoking had on gum health – Ms H became very upset by the information. She was unhappy with what she felt was an inaccurate assessment and left the surgery. Dr A was puzzled by her angry response to her findings.

A letter of complaint was received the following week. It stated that Dr A had exaggerated the extent of the problem and was “trying to find work looking for pockets” and putting pressure on Ms H to have x-rays. She also claimed that Dr A was “completely unprofessional” in her approach and was making things up to upset patients and worry them into getting unnecessary treatment.

Dr A was concerned by the way the letter questioned her professionalism and sought advice from Dental Protection, who assisted with the preparation of a robust reply.

The record entry for Ms H’s appointment was of great assistance in providing a comprehensive response. Dr A had recorded details of the clinical findings and diagnosis, including a full periodontal charting, as well as her advice on hygiene, interdental brushes, radiographs and her efforts with explaining the impact of smoking. In short, the notes provided a very clear picture of the appointment and the information given to the patient.

The response to the complaint included an expression of regret that Ms H was unhappy, but it was clarified that the treatment, information and advice given had been entirely appropriate. It was made clear that dental professionals have an obligation to provide accurate information to patients so they can make fully informed choices. Ms H was of course free to seek another opinion if she did not have confidence in Dr A’s advice.

Ms H wrote back to say that she would obtain another opinion from a dentist “she knew she could trust” and then she was going to “take it further” with Dr A’s lack of professionalism. Nothing further was ever heard.

Learning points

  • Although patients sometimes do not like being told the truth, it is in everyone’s interests for the real picture to be presented. Shielding a patient from an unpleasant truth does not help anyone.
  • Comprehensive notes are a very useful asset when defending against criticism.

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. 
For more detailed advice on any issues, contact us