This is a fictional case compiled from the DDU's files.

The scene

A principal dentist called the DDU's advice line about a patient who had requested additional aligners to complete his orthodontic treatment. The original treating dentist had left the practice, so the patient was booked with our member. Unfortunately, our member did not agree with her former colleague's treatment plan and was hesitant to continue the treatment.

As well as this, there were no other dentists at the practice who were suitably trained or confident to provide orthodontic treatment.

The member understood that she was in a difficult position, so phoned for advice on how best to manage this complex clinical situation.

DDU advice

The DDU adviser explained that the principal should carry out her own unbiased assessment of the patient and then explain her findings in terms and language that the patient understands. She should make sure the patient is fully informed about their current dental condition and that she explained all treatment options carefully.

Our adviser gave the member the following advice.

1. Only provide treatment you think is appropriate to meet the needs of the patient.
2. Explain to the patient in a sensitive way that there can be differences of opinion between clinicians about the best way to care for an individual patient.
3. Consider GDC Standard 4.2: "You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidance relevant to their situation. You may need to balance their oral health needs with their desired outcomes. If their desired outcomes are not achievable or is not in their best interests of their oral health, you must explain the risks, benefits, and likely outcomes to help them make a decision."
4. Keep accurate clinical records, including careful notes of any discussions with the patient and an audit trail of all decision making.
5. Consider a second opinion and/or a referral. Referral to an appropriate colleague in primary or secondary care should be considered if you believe this would be in the patient's best interests, or if you assess any aspect of the patient's care to be outside your scope of practice or competence (as indicated by GDC Standard 6.3.3).
6. Avoid making any inflammatory comments about care provided by other dental professionals.
7. Answer any patient questions honestly and factually.

Our adviser told the member to be aware that proposing an alternative treatment plan may result in a negative reaction, and potentially a future complaint - so it would be wise to handle any decision carefully and keep good records of any discussions she had with the patient, as well as the decision-making process.

The outcome

Our member felt more confident that she would be able to discuss the proposed treatment options available to the patient. She was reassured that if the patient did decide to complain about their treatment, she could ask the DDU for more advice.

The adviser also reminder the member of the DDU's contract reviewing service, which is available to all our self-employed dental professional members and practice owner members. They discussed that clauses in dental contracts can be used to protect both principal and associate members.