Bad mouthing

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bad mouthingYou’re examining a new patient and you realise the previous dentist did less-than-perfect work. Should you spill the beans or keep it to yourself? Angela Tufvesson investigates.

Every dentist is thrilled at the prospect of a new patient, especially given the potential for a long-term relationship and perhaps even recommendations to friends and family members. But developing a good relationship with a new patient isn’t always straightforward. Unless the new patient is a young child, chances are they’ve had dental work done in the past, which means you may need to contend with a range of techniques and degrees of professionalism. So what should dentists do if a patient complains about shoddy dental work or it’s clear that previous work isn’t up to scratch?

It’s best not to…

The simple answer is that dentists should avoid discussing the standard of work of other dentists with patients. The Dental Board of Australia (DBA) code of conduct says good relationships with colleagues and other practitioners strengthens the bond between dentist and patient, and enhances patient care. Specifically, it states that good practice involves “acknowledging and respecting the contribution of all practitioners involved in the care of the patient or client, and behaving professionally and courteously to colleagues and other practitioners at all times.”

Likewise, the Australian Dental Association (ADA) code of ethics says dentists should act at all times in a manner that upholds and enhances
the integrity, dignity and reputation of the profession.

If a patient seeks advice from a dentist who isn’t their usual practitioner about their oral condition, “the dentist should endeavour not to say anything which calls into question the integrity of their usual dentist”.

And you can’t really be sure

From a practical perspective, ADA president Dr Rick Olive says one of the main reasons to avoid bad-mouthing other dentists is it’s impossible to know the exact circumstances under which treatment was provided to a patient. “There’s an awful lot you can’t tell by looking in the patient’s mouth,” he says. “You don’t know necessarily when the treatment was done, and often dentists are asked to comment on things the patient said happened last week or last month or last year and what they’re concerned about may have actually been done many years previously.

“Patients often have a very poor understanding of what’s been happening in their mouth and of their previous treatments, so when a patient comes in and says, ‘This was done by so-and-so two months ago and I think it’s terrible’, it’s always sensible to be a bit cautious about taking that as the gospel truth.”

Dr Eryn Agnew, a community relations manager and professional consultant at the ADA Victorian Branch Dispute Assistance Service—a free helpline that assists consumers with dental health and treatment related enquiries—agrees that a patient’s recollection of treatment can be fuzzy at best.

“If you’re not in the room you don’t know what happened,” she says. “It could’ve been 5pm on a Friday, the patient is a terrible gagger and you can’t treat them very well, they’re going to a wedding the next day and just want a quick fix. So you do an emergency treatment but they don’t come back for two years.

“So what the new dentist may be seeing is a temporary job and the patient may not remember that or disclose it to the new dentist. The patient may have been given three or four different options and they may have selected a less-than-ideal solution, which has subsequently failed. Unless you know that entire history you shouldn’t be commenting on why it happened.”

“What the new dentist may be seeing is a temporary job and the patient may not remember that or disclose it to the new dentist.” –
Dr Eryn Agnew, ADA Victorian Branch Dispute Assistance Service.
But you can…

The DBA code of ethics requires practitioners to notify the board about other practitioners in some circumstances, including when they believe someone has “placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.”

However, Dr Agnew says this practice should be reserved for extreme cases. “Sometimes dentists will tell patients to go to the Australian Health Practitioner Regulation Agency (APHRA), but the regulator isn’t really interested in single instances—they’re interested in a pattern of behaviour or outcomes that mean the public is at risk.”

But she says dentists do have a legal obligation to disclose any issues with treatment to patients. Importantly, this must be done objectively and without apportioning blame. “If you see something or do something yourself, you’re meant to disclose it,” says Dr Agnew. “If you see something that’s not right, you need to say it professionally and objectively.”

Dr Philip Moss, a dentist at Katoomba Dental Centre, says discretion is a must during consultations with patients. “This has happened to me many times,” he says. “I’ve had to sit down and explain to the patient that more work needs to be done and discuss the work that has been done. The patient has sometimes been quite aghast about the fact that some previous work hasn’t been up to scratch and they need to have more work done.

“My response is not to accuse the previous dentist of not doing good work or bad work. I’ve just been able to explain as I see it what needs to be done. I can’t tell that patient that I feel their previous work has been sub-standard. It’s about being very open about everything, but also about not making accusations about any other professional’s abilities.”

Ultimately, Dr Olive says it’s important to stick to just the facts, especially if a patient presses you for dirt on their previous dentist. “If the patient asks what the dentist thinks of their treatment, I don’t think you have to cast any aspersions on another practitioner, but I think it is incumbent on the dentist to give an honest appraisal of the presenting condition.”

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1 COMMENT

  1. “Patients often have a very poor understanding of what’s been happening in their mouth…” As a patient, I am not a passive consumer of dental work. And dentistry has increasingly shifted toward a business model (Trathen & Gallagher, 2009) where profit-driven dentistry can cause problems related to over-treatment. If complaints about dentists have increased by 33.8% (Dental Board, 2016) why aren’t dentists directly resolving them? The second dentist, as an independent health care professional, surely has both an ethical and a legal obligation to disclose treatment issues to the patient.
    “But [APHRA] isn’t really interested in single instances- they’re interested in a pattern of behaviour….” A pattern of behaviour consists of single repeated incidences (the same behaviour repeated with different patients).

    References:
    Trathen, A., & Gallagher, J. E. (2009). Dental professionalism: definitions and debate. British Dental Journal, 206(5), 249-253.
    The second dentist and patient dissatisfaction. Dental RiskHQ, 16 May 2016. http://www.dentalriskhq.com.au/clinical-records/the-second-dentist-and-patient-dissatisfaction/

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