18 September 2014
The Office of Fair Trade recently investigated the business of dentistry and recommended that consideration should be given to providing guarantees for dental treatment. The GDC has wisely recognised that when treating a disease process there are a number of variables at play (not least being the active participation of the patient).
Consequently the requirement for a guarantee is not mandatory - instead the GDC advises that you should tell patients whether treatment is guaranteed, under what circumstances and for how long. You should also make clear any circumstances under which treatment is not guaranteed (for example, a lack of care on their part which leads to recurring problems or if the treatment is undertaken as a provisional solution in response to an emergency).
Unfortunately, guarantees fundamentally alter the nature of the contract between practitioner and patient, and may leave the practitioner unexpectedly exposed from a dento-legal perspective.
It is implicit in any contract to provide dental services that the clinician will carry out treatment with reasonable skill and care, exercising a level of skill that could reasonably be expected of someone holding himself out as possessing those skills.
A general dental practitioner is therefore expected to exercise the skills of a reasonable general dental practitioner.
Conversely, if the patient contracts with a specialist in a specific branch of dentistry, then the patient has a right to expect the specialist to display a higher level of care than that of a general dental practitioner. The same would obviously apply if the patient is seen by a recognised consultant in a hospital post.
If a dentist fulfils his/her ‘duty of care’ as described above, then, this is generally sufficient to rebut any allegation of negligence - although ultimately this is for the courts to decide.
However, if treatment is unsatisfactory or a problem arises, not due to any negligence on the dentist’s part, but simply because an alleged breach of contract on the dentist’s part, then an action brought against the dentist can still succeed, even in the absence of any clinical negligence.
There are no hard and fast rules governing how long a particular treatment should last, and indeed it would be curious if there were, given the infinitely variable nature of the human body and its function. A guarantee, however, imposes rules and standards which then become an integral part of the contract between dentist and patient, so that a dentist might be obliged to replace, at no cost to the patient, treatment which was neither negligent, nor which had failed to meet the normal terms, implied or otherwise, of a contract to provide dental services.
It is entirely possible, therefore, that a claim could arise which could have been successfully defended were it not for the presence of the ‘guarantee’ given by the practitioner when the treatment was provided. In such a situation, Dental Protection may not be able to provide assistance, if the practitioner had effectively given undertakings which had unilaterally, and without the knowledge of Dental Protection, extended his obligations to the patient.
Clearly it would not be equitable in a mutual organisation such as ours, if an individual member were to give binding ’guarantees’ (with a view to promoting his/her own practice), while expecting the cost of any claim upon these guarantees to be met by other members who had given no such guarantees.
If, on the other hand, it is clear that the patient’s claim would have succeeded whether or not the specific guarantee had been given, then clearly the member’s entitlement to assistance would merit consideration.