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The writing (should be) on the wall

15 July 2014
Patients cannot be relied upon to second-guess your treatment plans. Making sure they understand what is reasonably expected of them along with any consequences of non-compliance is essential...

A patient in her late teens requested orthodontic treatment, and after an initial consultation the alternatives of fixed and removable appliance therapy were explained and a written estimate of the fees involved with each of the alternatives was given.

The patient elected for removable appliance treatment, partly on grounds of cost but also on the grounds that she could envisage occasions when it would be embarrassing for her to be seen with fixed appliances in place. She was also told how long the treatment was likely to take.

As treatment proceeded, it became increasingly apparent that the appliance spent as much time out of the mouth as in it, and progress was extremely slow as a result. The patient became increasingly dissatisfied and things came to a head when the dentist said he wanted to increase the fees he was charging because of the extended treatment time.

The dentist pointed out that the patient had chosen the removable appliance, when fixed appliances had been strongly recommended, and it was her failure to wear this appliance as regularly as necessary to achieve the desired result as quickly as possible that had led to the present difficulties.

Two sides to the story

The patient was incensed and pointed out that she had been led to expect that the removable appliance treatment would take no longer than the fixed appliance treatment. The dentist said this was impossible unless the patient was going to wear the appliance as directed, to which the patient replied that it was up to the dentist to have pointed this out to her at the outset. She felt that she had wasted 18 months, and a lot of her time and money, to achieve virtually nothing.

The case was eventually resolved (with some difficulty) by referring the patient for fixed appliance treatment and by reimbursing half of the fees paid to date.

Learning point:

While patient compliance with instructions can sometimes waver, a clearly-worded written warning of the consequences of such non-compliance is some protection against future complaints.

Avoid cases like this by attending one of our Risk Management Workshops.

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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 members enjoy as part of their subscription. 
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