The Dental Council often receives calls from patients with concerns about treatment they have received.
The importance of good communication
Council staff provide advice on what next steps the patient can take, and usually encourage the patient to go back to their treatment provider in the first instance to see if they can resolve their concerns directly.
Two issues that have come to light recently may seem unrelated, but both stem from the same basic cause—a lack of clear communication between the treatment provider and their patient.
Good communication is fundamental to good practice and can usually prevent minor concerns or misunderstandings being escalated into full-blown problems.
The first issue relates to informed consent. Council staff received a telephone call from an upset patient regarding crown and bridge work. The patient had rung their treatment provider to ask if the appointment to fit their crown could be brought forward as they were going away.
The receptionist apologised and explained they could not get the crown back earlier because it was coming from overseas. The patient became upset and was quite adamant if she had known the technical work was being done in that particular country she would have gone elsewhere to have her dentistry done.
It reminds us of the importance of our informed consent processes. We have a responsibility to understand our patients’ priorities and values and perhaps where we are having our technical work done should be part of the information provided.
In the end, of course, it is the treating clinician’s responsibility for the standard of treatment provided and to be familiar with the materials and techniques used for laboratory work. The same applies to orthodontic procedures where information can be sent overseas for diagnosis, treatment planning and the manufacture of orthodontic appliances. The responsibility for clinical outcomes remains firmly with the primary clinician dealing with the patient. There may be advantages in communicating with a more experienced colleague nearby rather than taking advice from overseas.
In radiography there is now more sophisticated imaging equipment available in dentistry. There is a responsibility to be able to interpret the entire image taken and not just the field of view of interest to the clinician. Where necessary the image needs to be referred to an appropriate experienced clinician or even an overseas specialist. We need to remember that our overseas colleagues may not be registered as a health practitioners in New Zealand and extra caution is required.
The second issue relates to access to patient medical histories. In recent months, Council staff have received calls from patients who do not understand or accept why dentists require details of their medical histories which may contain private and very personal information. It can be helpful, sometimes, to have a brochure explaining why we, as oral health practitioners, need to be familiar with a patient’s general health, and at the same time to emphasise the privacy arrangements.
The Council’s patient information and records practice standard sets out the requirement for up-to-date medical histories for our patients. One way forward for particularly difficult interactions in this area could be for treatment providers to seek permission from the patient to contact their medical practitioner directly to discuss implications regarding the patient’s medical history—this may allow the oral health practitioner to gain an insight into any potential issues without full disclosure of the patient’s records.