PRACTICE MANAGEMENT
Ethics and aesthetics part II The second of two articles on ‘ethics and aesthetics’ looks at some of the key considerations that can help to reduce dento-legal risk when providing cosmetic dentistry, particularly in relation to patient expectations.
The importance of communication in all types of clinical care cannot be overstated. With respect to cosmetic treatment, careful attention to this is absolutely key to understanding what the clinician has been called upon to deliver. What the clinician sees, assesses, and measures in terms of the clinical presentation, and indeed the technical outcome, also needs to be seen through the eyes of the patient. It is, after all, the patient’s view that will decide if the treatment is successful in terms of achieving their desired outcome.
Some take-home points: n unrealistic expectations are often not identified or managed at an early stage;
n many complaints and claims arise from patients feeling that their expectations were not met;
n if there is any doubt at all about what is expected, it is wise to hold off on providing treatment; and,
n it is much better to be dealing with a patient unhappy with you for not ‘Need’ versus ‘want’ Treatment that is ‘needed’ in the clinical sense can be assessed by the clinician and will, by and large, be defined by the attention required to address the damage or pathology present. Cosmetic treatment, on the other hand, is generally elective, and as such chosen to satisfy a ‘want’ on the part of the patient. It is important to bear in mind this fundamental distinction. The ‘expectation difference’ between an intervention intended to repair something and one that is carried out to improve the appearance of something that is intact to start with, can be quite marked. Fixing something broken has a clear end point. Improving something that isn’t broken does not. In providing treatment of any sort, both dentist and patient need to know what
Dr Martin Foster BDS MPH DipHSM
providing cosmetic treatment than one unhappy that you have. the aim is. Treatment addressing an issue based upon what the patient desires rather than needs requires needs very careful consideration. Back to primum non nocere and all that. A clinician can assess need, but only the patient knows what they want. This can be complicated by the fact that some patients are unable to communicate this accurately so it can sometimes appear as if the patient themselves does not know what they want. The danger here is that a clinician faced with this situation may be tempted to use their skills in ascertaining need to identify what they feel the patient wants, or should want, based upon their clinician’s perspective. This approach is perfectly understandable, given our professional grounding in diagnosis and appropriate intervention. However, it can result in misunderstandings from the word go. If so, this will be destined to produce disappointment at a later date when it becomes clear that both parties were aiming towards different destinations.
Martin is Dentolegal Consultant
Working towards a shared understanding
at Dental Protection
In cases where there is any doubt at all about what the patient is really after, it is essential to delay treatment until both sides have a crystal clear Journal of the Irish Dental Association | Aug/Sept 2021: Vol 67 (4) 195
