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Managing unrealistic patient expectations

30 July 2018

A young female patient was suffering from pain that kept her awake at night. It seemed to come from tooth upper left seven with extensive dental decay and a missing buccal wall. The patient had an otherwise intact arch and was keen to have the tooth saved and expressed her strong desire not to have an extraction.

The dentist explained that a root canal treatment carries no guarantee of success, especially with the extent of damage to the coronal tissue. An extraction was offered as the only realistic solution.

The patient persisted in her demands for root treatment and the restoration of the tooth with a crown. She was unwilling to be referred to a specialist. The dentist felt pressurised by the patient and was naturally keen to help her, so embarked on the root treatment against her better judgment.

Three visits later, only two of the canals had been located and the third appeared to be perforated and bled on instrumentation. This was communicated to the patient and the tooth dressed. The patient would not consider extraction and was forceful in her request for the root treatment to be completed by the practitioner.

Further explanations were provided, but despite this the patient remained convinced that a crown would solve the problem.

The patient decided to visit a second dentist and was informed that the tooth had an incomplete root canal treatment. She wrote a letter of complaint to the first dentist questioning why the root canal treatment had not been completed in three visits and why she been charged for this incomplete and unsuccessful treatment.

While the clinical records were detailed, there were vulnerabilities for the practitioner regarding the clinical care provided in terms of:

  • the assessment of the restorability status of the tooth
  • the lack of adherence to recognised procedure
  • ·no rubber dam was placed due to lack of coronal tissue
  • a perforation occurred with an endodontic instrument.

Had the patient pursued the matter with a claim for clinical negligence, then the solicitors could potentially allege that the patient had been subjected to an inappropriate procedure with associate pain and suffering.  

With hindsight, the practitioner realised that the intervention had been a poor decision and should not have been embarked upon in the first place.

Learning points

  • Be alert to patient-led dentistry and demanding patients. Correct unrealistic expectations and communicate effectively with patients the reasons why the treatment they seek is not appropriate.
  • Avoid being bullied by domineering patients into treatments which are not expected to be clinically effective.
  • Simply because a patient consents to treatment does not mean that the treatment is appropriate.
  • In this particular case, the complaint was resolved by a thorough letter of explanation and a refund of dental charges.
  • The practitioner, in trying to appease the patient, had spent over three hours attempting treatment that was essentially clinically futile. They then had to spend further time managing the complaint that this generated, with all the associated stress.
  • This case highlights the dangers of attempting heroic dentistry; dentists are unlikely to be thanked for lack of success.
  • Unrealistic expectations should be managed carefully and the ground rules established early on.

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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