DENTAL PRACTICE


A friend in need M


Y medical colleagues oſten express amazement that dentists routinely treat their family and friends. Tis


is primarily because the GMC takes a very restrictive view of this practice, advising registrants to avoid “providing medical care to anyone with whom you have a close personal relationship”. Obviously, this rule is not invoked in


emergencies and I suspect that in other circumstances, such as where a doctor works in a remote setting, common sense is allowed to prevail. However, there’s plenty of anecdotal evidence that doctors take the GMC guidance very seriously and will generally arrange for relatives to be seen by another practitioner. Other than to provide stringent guidance


in relation to drug prescribing, the GDC has not imposed such restrictions. Tis is perhaps unsurprising since the practice of dentistry does not involve intimate examinations or life and death decisions. However, advice sought from MDDUS does indicate that a less formal dentist-patient relationship does present its own hazards.


Just a friendly handshake Firstly, there is the issue of consent. Ordinarily, before treatment can commence patients will be advised of factors such as the risks, benefits and alternatives. However, familiarity with a patient can make adherence to standard procedure seem unnecessary and even a little awkward. One particularly tricky aspect of


consenting close acquaintances is the issue of money, with dentists oſten feeling obligated to discount fees or “just charge the lab bill” as a gesture of goodwill. While this act of generosity is usually appreciated it oſten remains undocumented, an aberration which can unfortunately lead to problems.


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To paraphrase Mario Puzo, “friendship and money are like oil and water” – it’s not unknown for even the most generous price reduction to be subsequently challenged or even misrepresented as a tacit admission of substandard treatment. If there is no record of what was agreed and on what basis, the practitioner is leſt in a vulnerable position.


Clinical considerations Over-eagerness to help our friends may not only result in poor consenting, but may also skew our clinical judgement. It is quite understandable that, when treating those close to us, we may adopt practices that would not be routinely countenanced. A restorative plan, which would normally be regarded as over-ambitious, might just be attempted. A posterior resin might be claimed as NHS amalgam (in Scotland) to improve aesthetics and reduce the patient charges. Usually, treatment will proceed as


planned and any such aberrations will have no relevance. Even when problems do arise, good friends or immediate family members will generally accept the outcome and be appreciative of our efforts. However, it’s not hard to imagine


circumstances where, for example, a more distant or estranged relative takes a less indulgent view. Equally, former auxiliary staff who may have leſt the practice in less than amicable circumstances may feel disposed to second-guess any treatment offered to them gratis, particularly if it was of the exotic variety. Tese patients, who may have been quite happy to benefit from your kindness when all was going well, can prove to be especially ungrateful if the finished treatment does not meet expectations. If the investigation of a subsequent complaint reveals inadequate


Do the same rules for doctors treating family and friends apply to dentists? Maybe not to the same degree, says MDDUS dental adviser Doug Hamilton, but he urges caution


consenting or questionable treatment planning, the fact that these faults were a product of kindness will get little sympathy.


By the book Possibly the best means of pre-empting such problems and avoiding causing offence is to apply the correct rules uniformly. Written treatment plans and cost estimates are expressly required in most cases for both NHS and private patients. If the practice policy is to provide everyone (except, perhaps, your mother) with this document prior to treatment of any complexity then no-one, not even your best mate, should feel affronted. Equally, no-one can subsequently attempt to take advantage of your good nature by “misremembering” the agreed charges. Regardless of an appointment’s


informality, records must include all of the usual observations, such as examination results and details of the treatment provided. Where there are any doubts, don’t feel abashed about requiring a signature on the consenting document. Aſter all, this is the standard practice policy. Finally, don’t be tempted to consent your friend or discuss treatment in the course of exchanging personal e-mails. Te GDC have taken the view that all clinical information must be included in the patient records.


A convenient prescription If the provision of dentistry to family and friends is fraught with its own unique pitfalls, then the decision as to whether you should also write them a prescription is a real high-wire act. It is in relation to this particular facet of dentistry that the GDC has published Guidance on Prescribing Medicines which offers the following explicit guidance:


SUMMONS


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