COMPLAINT


ABUSIVE PATIENT


BACKGROUND Mr W appears at the dental surgery with a lost screw-retained post crown in UL5 that had been previously re-cemented. Dr T advises the patient that it will probably not last and a new post should be fitted prior to providing a new crown. An appointment is arranged but on later reviewing the X-ray the dentist has concern over the condition of the existing root filling and decides to schedule a shorter consultation to discuss treatment options. Mr W attends the appointment and is


annoyed that the treatment plan has changed. Dr T tries to explain his view on the necessity to carry out root treatment before refitting the post – but the discussion grows fraught. Mr W begins to shout, using aggressive and abusive language. Dr T manages to calm the situation and agrees to re-cement the old crown that afternoon. An appointment is made for the root treatment but the practice and Dr T are left


traumatised by the experience. Dr T sends the patient a treatment plan


and receives an angry letter of complaint, disputing the “extra” costs of the treatment made necessary by the dentist’s “indefensible clinical failure”. The dentist contacts an MDDUS dental adviser for advice on a draft letter of response.


ANALYSIS/OUTCOME The dental adviser reviews the letter and makes a few suggestions, including the need to set out a clinical justification for reviewing treatment options rather than just re-cementing the old crown. The dentist is also advised to set out in the letter the practice policy toward aggressive and abusive behaviour and state how Mr W’s actions and language will not be tolerated in future. Nothing more is heard on the matter and Mr W changes dental practice.


KEY POINTS ●Ensure you have a practice policy on dealing with abusive patients. ● Inform patients in advance of proposed changes to treatment plans.


CLAIM LIDOCAINE REACTION


BACKGROUND Mr U attends his dental surgery with a broken cusp at tooth LR6. Dr L examines the tooth and reassures the patient who seems particularly nervous in the chair. He advises that a new filling will be necessary and administers Lignospan (lidocaine) to block the nerve. Following administration of a third


injection Mr U reports feeling breathless and faint. He is placed in the recovery position on the floor and given oxygen and glucose gel. The patient asks about the anaesthetic and states that he has had previous reactions to lidocaine. An ambulance is summoned and Mr U’s


vitals are checked and found to be relatively normal at BP 175/80 and HR 68/min. The patient declines to go to hospital and leaves the practice under the care of his partner. Dr L later reviews the patient


notes and finds four separate written alerts stating that Mr U is “intolerant to lidocaine” and advising Citanest as the injectable anaesthetic of choice. Mr U has the necessary dental treatment


at a different dental surgery and a letter of claim is received by the practice alleging clinical negligence by Dr L in administering lidocaine despite a recorded intolerance. The letter states that Mr U is now suffering from dental phobia.


ANALYSIS/OUTCOME MDDUS reviews the case papers along with a psychological assessment of the patient organised by his solicitors. Dr L admits that administering the lidocaine was an oversight on his part and a clear breach of duty of care. It is the consequences of this breach (causation) that are subject to dispute.


Mr U admits that he recovered quickly


from the adverse reaction with no lasting physical effects. However, he has since been diagnosed with dental phobia. Cognitive behaviour therapy has been advised with graded exposure over 10-12 sessions. Given the obvious error in not carefully


checking the patient records and also considering causation, MDDUS settles the case in agreement with the member.


KEY POINTS ●Ensure strict protocols for highlighting potential adverse drug reactions. ●Double check with patients for “any allergies or bad reactions”.


MDDUS INSIGHT / 19


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