Years of Malpractice – How Is It Possible?

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Where there is smoke, there is fire. Dentists negligent behaviour should be act upon.

Ever wondered how it is possible that the dentists who are not practicing dentistry up to the standards get caught only after years of practicing the profession? Well you have come to the right place to find out.

Is It the Patients’ Fault?

Nope. Absolutely not.

The patients cannot tell the difference between a good and bad dentist when it comes to the skills of a dentist. Or if the procedures have been done as they should and if they are necessary in the first place. Or if the instruments entering their mouth have been properly cleaned (take a look at my previous post about this).

An average patient can only judge the dentist by the looks of him and the practice, and by the dentist’s chair-side manners. The rest is build on a trust of receiving good and adequate care. But every once in a while this trust is broken and the dentist ends up in the headlines.

But please remember that not all the dentists ending up to the headlines are rogue dentists as I have written previously.

Collegiality Gone Bad

Collegiality between the dentists means respect to one another’s abilities to work towards the same purpose. Helping patients. But collegiality has an ugly side as well. It is an unwritten code between the dentists which means one should not interfere or especially under any circumstances criticise a fellow dentist’s work. It is a code one should not break. The hygienists are expected to play by the same rules.

Now, this creates a problem. When a dentist is underperforming, the colleagues hear this from the hygienists and nurses. They see see it from the teeth of the patients who come too see them instead of their regular dentist (e.g. for emergency visit or whilst the regular dentist is on a holiday). They know there is a problem but very rarely they raise questions.

Instead the patient is kept under an illusion that the regular dentist has made the right decisions by distorting the truth.

Distorted truth:

“This decay is in such a difficult area to notice.”

The truth:

“This massive decay is so big that even my half-blind grandmother would find it.”

Distorted truth:

“Your dentist has marked it as an early decay, something to be kept an eye on… it has now grown bigger and needs a filling.”

The truth:

“Your dentist needs to have his eyes checked. This decay should have been filled ages ago. If you are lucky enough, you avoid the root canal treatment.”

Conclusion

It should be every dentist’s duty to report problems in colleague’s way of practicing dentistry. The Code of Ethics by ADA state the following:

Dentists should be aware that jurisdictional laws vary in their definitions of abuse and neglect, in their reporting requirements and the extent to which immunity is granted to good faith reporters. The variances may raise potential legal and other risks that should be considered, while keeping in mind the duty to put the welfare of the patient first. Therefore a dentist’s ethical obligation to identify and report suspected cases of abuse and neglect can vary from one jurisdiction to another

In my opinion, you don’t pull out the biggest guns if you suspect negligent behaviour from your colleague. The dentist in question should be given adequate time to correct the problem e.g. by revising.

The privilege of dentists to be accorded professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society. All dentists, therefore, have the obligation of keeping their knowledge and skill current.

If nothing changes, more severe means should take place. This includes giving warnings and as a last resort filing a complaint to the relevant authorities.

Naturally, if the negligence is severe, one should not hesitate to contact authorities urgently.

The bible of dentistry aka ADA’s Code of Ethics 2018 in full.

 

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Morals in Dentistry

Where It All Started

Compensation Culture Sucks

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A 30-year-old lady had been to see a hygienist for a scale and polish, went home and took a small mirror that she put inside her mouth to have a look behind her front teeth.

“Stains!!”

She went back to the surgery and complained to the receptionist about inadequate scaling. She was booked in to see another hygienist who confirmed there were some stains left behind (palatally) the upper front teeth. Otherwise the scaling was done well enough.

Patient left the practice seemingly happy but the next day she called the practice that she still wasn’t happy. She also complained about the dentist she had seen.

The hygienists and the dentist discussed about the patient and came into conclusion that this patient could not be pleased and the complaints would be never-ending. They all had had the same feeling about the patient when she was in the chair. It was a feeling of unease and of a need to explain excessively everything they were doing or saying to avoid a complaint. They decided together that the patient would not be welcomed anymore and the practice manager was the one to break the news to the patient.

Thankfully the practice owner was supportive over the decision.  He said

“We don’t need that kind of patient in our practice. She will only bring bad blood and it’s just not worth it. We can’t help her.”

The Compensation Culture

The compensation culture in the UK (and perhaps even more so in the US) is making a life of a dental professional very hard. It is ludicrous that the main focus of seeing the patients is in the avoidance of possible complaint.

The rotten apples amongst us dental professionals are perhaps to blame. And the media has done their share as well (has there actually been a program about rogue dentists?). The way the media is sharing news is focused on gruesome headlines and there seem to be less and less investigative journalists in the payroll of the media. Instead there are these copy-paste-wannabe-journalists whose main focus and reason for existence is to get as many clicks as possible on their news. Here’s one example:

Dental anguish: Indiana man who expected to have four teeth pulled woke up in hospital TOOTHLESS” (Find the news here)

This and similar headlines were quickly released around the world without giving the dentist a chance to respond. He would have wanted to respond, I’m sure but there are laws that prevent us dental professionals responding publicly to the accusations made against us when it is about doctor-patient relationship.

Later on the dentist was allowed to discuss the patient case but far fewer media released his response (you can find the response here). So the dentist suffered financial loss over these headlines only because the media is fishing the clicks. Of course there wouldn’t be these headlines if there weren’t people clicking them…

Learn the Phrases

You know what? It is time to fight back the compensation culture. You can do this by learning to use certain phrases. I will list the phrases I use myself when I see a patient. And without sounding like a super human, I rarely get complaints. It is just the opposite. People are happy after they have seen me.

And before you tell me that there is no time to explain everything to the patient I will say that it takes no extra time. You can use the time when you have your fingers inside the patient’s mouth. Don’t wait until you are finished with the treatment. You chit-chatting might even relax the patient!

Ok here we go and remember these are just examples and you can easily create your own phrases for every situation.

The phrases need to cover:

Post-operative pain/sensitivity/bleeding and instructions

“The gums might feel tender afterwards and it is ok to take a painkiller for them. But do not take aspirin because it might make the gums bleed.”

“Sometimes the teeth get sensitive after scaling which normally will pass very soon. If prolonged it is advised to use a sensitive toothpaste.” 

“Some stains cannot be removed by scale and polish. They are in the deep grooves or inside the enamel or between the filling and a tooth and only replacing the filling will help.”

“The teeth will feel very different afterwards as the tongue has got used to the tartar. You will feel the gaps between the teeth.”

Looks and the feel of the new filling

“You might have sensitivity after new white filling and in the worst case the sensitivity can last for months but it should gradually get less and less. If not, you need to come back to have it checked. And if the pain gets worse you need to come back straight away.”

“The filling is never the same as your natural tooth (so you should think twice next time before you snack between the meals and neglect the teeth… )”

The list of these phrases is endless.

And the most important thing is to remember to write down every advice and information you have given so that it can be easily checked what the patient was told if they complain. In this digital age it is a matter of copy-paste if you have created templates on you computer.

Tell What You Do

It takes no extra effort to babble while you are treating the patient. Of course some people won’t like us talking while we treat them but telling the basic stuff is normally ok. This means very simply informing the patient what you are going to do next.

“I’m going to tilt the seat back…”

“I will rinse now..”

“I will use a drill next. There will be water and you will feel vibration…”

I hear it numerous times per week that the patient felt it was good that I told everything I did. I think it is only respectful thing to do. After all patients come to see us, trust their health in our hands and pay our wages.

There. Now go on and try these advises out! I’m sure you won’t regret it.

Yet Another Anti-Patient

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How on earth did I not remember this type of Anti-Patient? I guess it is all coming slowly (but surely) back to me after returning to work.

Before you read any further, it might be good idea to read my post Anti-Patient so you know what I am on about.

Anti-Local Anesthesia

Now, this type of patient is not so uncommon in the dental chair. Let me tell you about the two of the most typical situations I face.

Patient Case I

I am about to start the scaling and root planing and I can tell from the looks of the gum that it is going to be painful. I offer local anesthesia (LA) but the patient declines by saying:

“I once had such a bad experience with LA that I have not taken any since..”

Or

“Oh, I never take any LA, not even when I have a filling done.”

I explain that it will most likely hurt but the patient does not change his mind. Not even when I explain we could use topical LA (I use Oraqix) which would not require needles.

So I begin the treatment. The sonic scaler goes relatively well but when I begin to scale those deep pockets the patient is jumpy (as if somebody was poking his limbs with a needle), turns his head suddenly (exaggeratingly) and is kinda slowly sliding towards my lap as he’s pushing from the handles of the chair.

After I have nearly injured my own finger and patient’s lips for the third time because of the unpredictable motions and after I have three times asked patient not to move his head, I stop the scaling and tell the patient that I won’t be able to carry on unless he keeps the head absolutely still. Because it’s not safe. I offer the LA again and usually at this point they agree.

Patient Case II

The patient (who also just declined LA) keeps still throughout the treatment (scaling) and says she’s fine when I ask her if she’s ok  (multiple times). So naturally I carry on to finish the treatment.

Once the patient gets up from the chair she does not look happy and says

“It hurt a lot.”

Or

“Oh I hate having this done.”

Or

“It’s never hurt before.”

Soooo annoying! Did I or did I not offer you LA? Of course it hurts if you decline LA when it is recommended. And why would you say you are fine when you are not?

What is the most annoying in all this is that she will go and tell ten of her mates how horrible experience it is to have the teeth cleaned. Simple marketing rule – bad experiences you tell to ten people, good experiences to one. So unfair!