Question:
I had a patient (on welfare) in my office today that required an addition to
a partial denture. Seems the patient went up the road to a local dentist and
had 3 teeth that were troublesome extracted earlier this week. #'s 1, 4, and
16 (1.8, 1.5 and 2.8). While talking to the patient I asked if they had any
other problems, the pt. promptly points to 17 (3.8) and says it's sore. It
took me mere seconds to see a bridge flapping in the breeze. Abutments were
17 (3.8) and 20 (3.5) with pontics in between. Obviously the molar was soon
to be lost and is compromising the premolar.
Continuing my cursory assessment I observed a large carious lesion on the
distal of 6 (1.3) the tooth I was to clasp. The lesion was 5.5mmW X 3mmH X
3mmD in size. This was the last tooth in the quadrant. I then asked the pt.
when they were going back to the dentist to look after the other problems
that needed fixing. The pt. replied that no other problems were even
mentioned. Amazed at this I phoned up the dentist to discuss my concerns of
the patient. The dentist replied that he did not do an exam as he would only
get paid for the extractions.
Had this idiot even open his eyes and ears - he could have picked up and
been paid for another extraction and filling at the same appointment. OK so
he would have had to segment the bridge, but a hack saw would have run
through the very visible solder joint on the distal of #20 (3.5). He'd have
more money in his pocket and the patient would most likely keep 2 teeth a
whole lot longer. All this without an "EXAM".
Before I call my association on Monday to find out if I am obligated to
report this negligence, I thought I would get the opinion from the people
here at s.m.d.
Do all people on welfare receive such minimal care?
Do you consider the lack of observation, barring an exam fee to be
negligence?
Am I wrong to be concerned?
Is this reportable? Why or why not?
Answer:
yes. prior to any extraction(s) (even for
emergency reasons) at least a minimal
cursary exam of the rest of the mouth,
necessary radiographs, and a verbal
medical history is IMHO required.
yes and no. how involved do you want
to get? Is this a one time oversight? Does
this dentist already have a reputation in the
town? Certainly the patient should report
this incident to the proper agencies,
It is up to the patient to make an appointment with a legal licensed
dentist to request "full treatment" not just an emergency visit for a
couple of quick pullings. This requires some treatment planning and
some follow through.
No negligence involved. I have done something similar 1000 times. I
write in the chart, "Patient advised to return for treatment planning
and complete care." The patient does not do it. It is not my problem.
I have covered my actions or lack thereof. I am certain your dentist,
if he treats welfare patients, knows all about this.
Yes, if they fail to call a dentist to get the care. Welfare dentists
do not make house calls and they do not beg patients to make
appointments.
Actually you are right to be concerned, but please redirect your
patient to get himself/herself to a dentist. There are many, many
dentists in every town.
Yes and No in a convoluted way, thanks to the law. IMHO personally and
professionaly interaction is a good idea for all involved. Law says we can
assess not diagnose. Professional misconduct not to refer upwards when
required. Professional misconduct not to communicate to a patient a
condition we have seen or "ought" to have seen. For this patient because of
potential language problems a letter was written to the patient explaining
my observations and reccommended actions. Specifically "it appears that your
bridge is loose, and you have a large hole in your tooth, you should see a
dentist for treatment"
That has nothing to do with it Joel. Even if the dentist was doing the
repair/addition do you really think the need for treatment would have been
communicated to this patient if the DDS was not getting paid to do an exam.
Think about it.
The patient initially came into my office to learn how to get the work done.
I told him to go to one of the local dentists and get the teeth he wanted
pulled checked out. Once the teeth were pulled I could then add to his
existing denture. I do not expect that a full treatment plan and all
treatment be done in one appointment. I do expect that some work including
observing the need for blatant treatment be noticed and communicated with
the patient.
The teeth were extracted and the patient dismissed, no advice at all from
what I was told. That is what prompted my call to the dentist. If I knew he
was told to go back then I have to assume that a need for further treatment
was observed. Come now Joel we both know that the need for treatment is
quickly and easily identified. It is the documentation and communication of
that need that takes the time.
I find it difficult to understand and believe that a patient walking into a
dental office as an emergency with an unbearable pain, and insisting on
getting an extraction for reason of money or pain or whatever , must go
through a complete dental exam including radiographs etc.
Many a times patient wants relief and not a lecture on how he should take
care of his teeth. It is our obligation to inform him of his choices and why
he should be salvaging his tooth however, if you do not extract teeth, then
you better inform him before you subject him to an exam/x-rays and a
lecture that you do not plan to pull his tooth if he so desires. You also
should then post a sign that you do not pull teeth.
I have a fee for service practice and I do not see welfare patients, how
ever I always had an open policy of treating emergencies "As Long As They
Are Willing To Wait" ...! I do this as a public service and I am cheaper
than a local hospital emergency dental care which charges $150 for an
emergency care and plus. I also want everyone to know that in last 18 years
of practice, I have gone to my office for emergencies, after office hours,
for a total 4 times of which 2 were my relatives.
It is negligent, only if you do see him again as an emergency and have not
insisted on seeing patient that next time for an examination. We have
obligation to take people out of pain. We are not obligated to along
repeated "offenders" who do not seem to much care for good dental practices
and oral health.
In so many years, I have and treated many families. There are so many
mothers that I know, that have chosen to take care of their kids and neglect
themselves or rather postpone their treatment...
Not everyone is fortunate to be able to afford good dentistry and for those
unfortunate ones, we have to provide some relief. We are also a country of
immigrants, especially in the large cities, who have different values about
dental health. While we continue to educate people of different mindset,
ethnicity and background on benefits of good dental care, we also must
provide minimal oral care as necessary, when necessary as long as it is
provided on sound reasons.
