It can be extremely rewarding and enjoyable to work in a practice where there are several practitioners and support staff. However, this can also mean that there will be times when our patients will be treated and cared for by our colleagues and conversely there will be times when we will have to care for our colleagues’ patients. When preparing to meet patients for the first time we are often able to rely on their clinical records to ensure the continuity of their care, and if the records permit, an insight into who these patients are can be gleaned. At the very least we can utilize their records to establish an initial rapport by inquiring about their most recent appointment and asking how they have been in the interim. 

Unfortunately, this same opportunity is rarely reciprocated for patients, and it comes as a surprise when they attend their appointment and are told they are seeing someone else or someone new. I’m sure many of us can recall a time when we have happily strolled out to the reception area, introduced ourselves to the patient and invited them into the treatment room, only to be met by the patient’s obvious shock or even worse contempt. After an awkward moment we realise that our patient attended their appointment expecting to see their regular dentist, hygienist or OHT and as such, that horrible feeling of dread and anticipation that we have already stared out on the back foot, is difficult to ignore.

The case study below is a scenario many of us either recognise or have encountered. 

Mr. T had landed his ideal role in a long-standing busy dental practice. The practice was expanding, and they had decided to create a new role within the team for an oral health therapist. Both existing dentists had worked independently for many years and welcomed the prospect of another set of hands to assist with the treatment and care of their patients.

Mr. T’s appointment book was quickly filled out by the administrative team, which equated to a much needed reduction in the appointment wait lists for Dr G and Dr P, so it really felt like a win-win for everyone. 

Mr. T had been working in the practice for a number of months, and all seemed to be going well. His schedule for this particular day concluded with a family visit for Miss M (8 years old) and Mr. T (10 years old), and they were accompanied by their mother Ms. B.

When Mr. T happily greeted the family and introduced himself as the ‘new oral heath therapist’, he sensed immediately that something didn’t seem quite right with Ms. B. Though, comparatively the children seemed excited to meet Mr. T and headed straight down to the treatment room, with Ms. B trailing behind. 

During Miss M’s appointment, Mr. T advised the mother that Miss M needed a small restoration, in fact her first ever filling. Once again, he noticed Ms. B seemed hesitant and when she asked if Mr. T was sure about the filling because Dr J had only examined her daughter’s teeth six months earlier and said they were perfect, there was part of him that was not surprised. Although Mr. T sensed Ms. B’s reservations towards him however, he genuinely wanted to build rapport between them, so he spent extra time going over the x-rays and the intraoral images, hoping to bridge this gap and establish the initial stages of mutual trust. 

After they said their goodbyes, Mr. T returned to the surgery and checked his book and felt reassured in his efforts when he saw that Ms. B had scheduled Miss M’s next appointment with him. When Miss M returned for her treatment, Mr. T explained the restorative procedure and assured Miss M that she could let him know if she needed a break. He then commenced treatment and was very surprised when Miss M became fidgety and unwilling to cooperate, despite his best efforts. He attended to the patient’s needs, stopping, and provided rest breaks and confirmed that both she and her mother, Ms. B, were happy to proceed prior to resuming any treatment. With much effort, patience, and kindness he was able to complete the restoration and congratulated Miss M on her bravery and persistence and also Ms. B for being a great support. 

He thanked Miss M and her mother for attending their appointment and continued on with his day. The next day Mr. T was informed that Ms B was unhappy with her daughter’s appointment and Mr. T’s care.

Ms. B had sent an email setting out her discontent:

“We arrived expecting to See Dr J, as we have done so for the last six years and were told we were seeing a ‘Mr. T’ the ‘new’ Oral health therapist. 

No one had explained to me that we would be seeing someone else or even asked if we were OK with this. Because we weren’t! Also, my appointment was made six months ago so there was ample time to let us know. 

Prior to our appointment we had never met Mr. T or even heard of him and what’s more I had to go home and search online to see what an Oral Health Therapist was. All of this after he had already examined my two children and after I had made an appointment for my daughter’s filling. I am extremely angry and disappointed that I wasn’t even given any choice in the matter. I mean no offense to Mr. T (I suppose) but surely this is something that I should have a say in.  

My daughter’s appointment was awful, she seemed really uncomfortable, and they had to keep stopping and coaxing her on. I get that he was doing his best, but this never happened with Dr J, albeit that she hasn’t had a filling before.  

When I went out to settle the account, I expected that the fee would be reduced given Mr. T isn’t a dentist and I was surprised when it was explained to me that the fee was the same irrespective of which practitioner provided the treatment.  

Had I known this to be the case, I would have waited to see Dr J, and what’s more I should be able to choose who we see. If there are changes to our appointments, then I should be notified of this at the very least and given the opportunity to decide whether we attend.” 

Mr. T read over Ms. B’s email and realized that most of her concerns were not directly related to Mr. T’s treatment or his care of her children but a result of poor communication and a feeling that she/they had been abandoned by Dr J, then shuffled onto Mr. T without her consent. Ms. B and her family had a longstanding relationship with Dr J and the practice, and this lack of communication and ‘care’ had left her feeling very upset.

Interestingly, in this case there wasn’t an actual tipping point, where something happened that changed the course of treatment or affected an existing relationship. In this situation, there were obstacles already in play, even before Mr. T walked out to meet and introduce himself to the family. Every time something was said or was different to their usual visits with Dr J, this solidified Ms. B’s contempt for not being included in the decision to transfer their care to Mr. T. This decision had been made without her knowledge or her consent, and Mr. T was unfairly compared and scrutinized as a result. Unfortunately, Ms. B no longer felt like she was an equal partner in her care but more like a number and she considered this a personal affront after years of being a loyal patient.

This case highlights the importance of good communication and consent across the entirety of our patient’s care. Had the practice and Dr J, let Ms. B know that she would be seeing Mr. T, and explained his role in the practice, things might have been different. Though Ms. B may not have been happy that her appointment had been moved to Mr. T she would not have been surprised and most importantly (and in Ms. B’s mind) she would be given an opportunity to consider her options and decide whether this new modality of care suited her and her family.

When considering this case, we might apply the old adage: “what we tell our patients prior, is an explanation and what we tell them after, is an excuse”. Patients don’t like excuses, nor do they want to be cared for by a practitioner or practice who applies a paternalistic filter over their care. In fact, Ms. B and Mr. T’s case is a good reminder that the conversation of consent is not only confined to our discussion about treatment but a necessary consideration in all aspects of our therapeutic relationship, from the very beginning to the end.