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We can all learn from an unfortunate incident involving a member of the clinical team.

Although these cases are based on real events, some of the details have been fictionalised to ensure the confidentiality of the people involved.

I look like a horse

13 July 2021

When a patient makes a comment such as this, it can be difficult to know how to respond, but also figure out where it went wrong. Dr Annalene Weston, Dentolegal Consultant at Dental Protection, shares a case where the patient actually made this very accusation

Ms W, a social media influencer, did a great deal of research on achieving the exact smile she wanted. Ms W scheduled an appointment for an assessment for veneers with high expectations for the treatment she would receive from Dr B.

Dr B assessed Ms W and found that she had small square teeth, which he believed was the root cause of her dissatisfaction with her smile. Ms W showed Dr B a number of images of celebrities, saying she wished for a smile just like them. Dr B designed a smile in accordance with her request and reassured her that her smile will be “bigger”, showing her a digital image of the proposed final result.. Ms W connected with the outcome of the digital image and although her smile design did not quite give her the same breadth of smile she was hoping for, she made some assumptions that her outcome would be the same as the images she had provided.

Ms W booked in as quickly as she could and tolerated the temporaries, which she hated. She requested no changes be made to the final shape and size of the teeth, despite encouragement from Dr B to speak up about any concerns she may have. She did not understand that the temporaries were a replica of her final outcome. This disconnect between the two of them continued, with Ms W focused on what she thought she was getting, and Dr B making the assumption that ‘silence equals consent’. 

After cementation Ms W was devastated by her appearance. She found the teeth too long, and they affected her speech. She was also experiencing pain. Dr B’s practice made several calls to invite her in for a follow-up to check on her, which she ignored because she was upset and embarrassed and no longer trusted Dr B. With the passage of time, the tone of these calls changed to chase up the outstanding account. Ms W became withdrawn, and her feelings about her teeth impacted her ability to work, socialise and leave the house. She did not want to pay for the work because she hated it. This was made worse by the fact she was in pain. As the calls and letters from the practice continued to come thick and fast, Ms W looked into what her options were and what action she needed to take  to make it all stop.

Dr B received a statement of claim, which is a document telling him he is being sued by Ms W, on the grounds that he provided treatment to her without her consent. A review of his records quickly revealed that there was no documentation regarding any of the conversations relating to consent, which was compounded by Ms W not having  signed her consent form. Things got worse from there for Dr B, as all of his records were lacking in any detail. Consequently, this made it incredibly difficult for Dr B to  defend his position against the allegations. 

The matter was settled out of court by Dental Protection on behalf of Dr B.
 

Learning points

• Don’t rush into elective cosmetic treatment without first ensuring you understand your patient’s needs. Communication is key, ensure you are listing to the patient, recognise their expectations and consider whether you are able to meet them.

• Obtaining a valid consent is crucial in contributing to a successful treatment outcome. Ensure that all conversations with patients are documented in your clinical records to reflect you have provided all the relevant information to the patient, along with any risks, benefits or limitations the intended treatment may bring.