I know of a number of dental offices where the reception staff believe that allowing patients to defer, delay or even postpone their dental appointments is quite OK, because in so doing, these dental staff believe they are providing great customer service to the patients, by allowing the patients to choose a time that is “less inconvenient” to their busy schedules.

But consider this:

In medical terms, if a doctor recommends to a patient a course of treatment, should the patient be “permitted” to delay or defer that treatment?

In reality, is there a compelling reason why patients should allow anything, ranging from “social events” to “I’m not feeling well” to be used as a reason for delaying diagnosed medical treatment?

In the provision of health services, the question [or debate] is often raised as to whether letting a patient choose whether they [the patient] should be able to defer or delay diagnosed treatment, is best practice, or is negligence.

And in dentistry, where time is our enemy, are we as a dental office then negligent for allowing our patients to delay their diagnosed treatment?

Because in delaying, aren’t patients then allowing cavities to become bigger, pockets to become deeper, cracks to further propagate?

Does caries advance with time?

Do cavities get deeper if we leave them for a period of time?

Medical practitioners have a duty to exercise reasonable care and skill in the treatment of patients. This duty extends to the examination, diagnosis and treatment of the patient, the provision of information, and follow up.

RACGP Standards:

The Royal Australian College of General Practitioners for medical doctors has a list of Standards for General Practices. And interestingly, Criterion 1.5.4: System for follow-up of tests and results includes the following:

  • The GP’s and practice’s responsibilities reflect the recognition that the GP-patient relationship is a special one based on trust. It is also characterised by the GP having knowledge that the patient generally does not have.
  • The practice needs a system aimed to ensure that clinically significant tests and results are followed up. The system needs to be designed to anticipate that individual cases will require different levels of follow-up depending on the clinical significance of the case.

The following factors are important in determining whether something is clinically significant and therefore requires follow-up:

 

  • The probability that the patient will be harmed if adequate follow-up does not occur
  • The likely seriousness of the harm
  • The burden of taking steps to avoid the risk of harm

 

In my opinion:

In my opinion, a dental practice that diagnoses disease and fails to do everything in its power to have the patient treat that disease and remove it or control it, is failing in its duty of care.

In my opinion, the diagnosis of decay, periodontal disease, malocclusion, bruxism, and sleep related issues, are all diseases that cause harm if left untreated.

Allowing patients to delay treatment longer than the originally recommended time frame allows the disease to advance and get worse.

The Dentist has knowledge that the patient generally does not have.

And there is a definite probability that the patient will be harmed if adequate follow-up and follow-through does not occur.

As health care professionals [and I include dental office employees in that category], we OWE IT TO OUR PATIENTS to ensure that they complete all the necessary treatment that our dentists diagnose for them.

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