If you can’t genuinely claim competence in a procedure, you shouldn’t carry it out. Referring to someone who can is the best option…
A patient approached her dentist and said she wanted ‘to acquire a perfect smile just as quickly as possible’. An instant makeover was what she had in mind. She had started a modelling career that had now progressed to film roles and she had slightly uneven front teeth and various unsightly fillings in posterior teeth.
The practitioner was in general practice and carried out a significant number of crown preparations in the course of his work. Having been qualified many years, he was in the habit of providing mostly bonded restorations.
The patient insisted that no metal should be visible from any angle when the treatment was complete and the practitioner told her this would be no problem with all-porcelain crowns. In reality the dentist had little experience of full mouth restoration and even less of porcelain crowns.
Bulky and unreal
The patient wanted the work carried out quickly and so the dentist went ahead. The appearance of the finished crowns was not acceptable to the patient who said they looked bulky and unreal.
Not only did the dentist re-prepare and re-make the crowns, but also some of them had to be re-made twice. Possibly due to inexperience or simply in response to the relief that the appearance was at last acceptable, the crowns were permanently cemented and the patient was told that the treatment was now complete.
The patient returned with pain the following week. An occlusal problem was diagnosed but attempts to correct this made the posterior crowns look increasingly like flat porcelain slabs and worse still, it failed to correct the problems.
The patient had grown increasingly unhappy and the dentist contacted Dental Protection for advice. The case was referred for an expert report. Sadly this was not entirely supportive of the work carried out and recommended that almost all of the work should be re-done, at a much higher sum than originally charged to the patient.
To maintain the dentist’s professional integrity and reputation, it was agreed to settle the case on his behalf. The patient had not yet gone to lawyers and it was therefore proposed that ‘as the treatment had not met her expectations [an understatement] she would not be charged for it to be re-done and the member would reimburse the new dentist himself’.
Since the dentist refunded the fee for the original treatment, effectively all the work was carried out free as full and final settlement – but it was cheap at the price for peace of mind.
Learning point: If you anticipate a case will exceeded your own personal skill levels, refer the patient to a more experienced colleague. Increase your own skills for handling more complex cases by attending the appropriate courses as part of personal development plan.