Who Will Defend Us?

Most of my patients` dental problems were caused by the bad dentist that treated them as children. At least, that`s what my patients tell me. Whoever this bad dentist was, he sure must have had a big practice! These patients` problems were never caused by the fact that they have refused repeated referrals to periodontists or that they do not floss. We should heed the spirit of Ronald Reagan`s Eleventh Commandment: "Thou shall not speak ill of another Republican." Let`s not criticize other den

Patrick Wahl, DMD

Most of my patients` dental problems were caused by the bad dentist that treated them as children. At least, that`s what my patients tell me. Whoever this bad dentist was, he sure must have had a big practice! These patients` problems were never caused by the fact that they have refused repeated referrals to periodontists or that they do not floss. We should heed the spirit of Ronald Reagan`s Eleventh Commandment: "Thou shall not speak ill of another Republican." Let`s not criticize other dentists.

When you criticize dental work without knowing the circumstances under which it was performed, you`re telling the patient, "You`re stupid; you went to a bad dentist." In fact, you make the entire profession look bad by sending the message, "Dentists can`t be trusted." Do you know if the patient kept all her appointments? Did she follow through on the treatment recommendations? Like any other profession, there are, of course, some dentists who can`t be trusted, but the vast majority are caring and committed, and that`s the message that we should send.

Have you heard the latest commercials for AT&T and MCI? The gloves have come off, and the ads have become truly vicious, with MCI commercials singing that AT&T`s claims just don`t "ring true," all to the tune of AT&T`s very own theme music. These ads are very entertaining, but I think that they will hurt both AT&T and MCI. How many of us will trust the claims of either one?

Bad things happen to every practitioner. When I was an endodontic resident, a patient I had treated came back months afterwards with swelling. A radiograph revealed that the tooth had been perforated by a post performed by the patient`s dental student. I asked my instructor what I should tell the patient. He replied, "Send him back to restorative-it`s their problem." I hope this is not the attitude of the dentist that might see a patient of mine after I achieve a result that is less than ideal.

This patient, like most patients, was a very nice man who probably already knew that something had gone wrong and the tooth might need to be extracted. I told him that it was a very difficult tooth to restore; we all did everything we could, but that the tooth was probably too weakened to last a long time, and he would be better off with a bridge.The patient didn`t want to sue anybody, he just wanted to get better, and he wanted to continue treatment with the same caring and committed professionals who were working hard to this end.

A new patient recently came into the dental school where I now teach, wanting a new partial. One of the abutment teeth had an unusual radiographic appearance. Although the tooth was asymptomatic with no evidence of infection, there were three posts which appeared to have perforated each of the three roots, none of which showed any sign of prior endodontic treatment. It was decided that the best thing in this particular case was to leave it alone, but to make the new partial with this tooth`s poor prognosis in mind.

Another instructor then told the student, "Show the patient the X-ray, show her the perforations and tell her what was done wrong." That patient had no complaint. She`s not a dentist, so she doesn`t know how to read X-rays. Why not explain to her, "As you know, Mrs. Smith, this tooth has had a lot of work in the past, and it`s a compromised situation. It seems OK for now, but you may not keep this tooth for a lifetime. We`ll keep an eye on it."

Once in a while, a patient may ask difficult questions, but the vast majority do not. We must keep our patients fully informed, and it can be a challenge to do so in a diplomatic and matter-of-fact fashion. No good is gained by stirring up unnecessary litigation that doesn`t help patients get better. Malpractice litigation, almost without exception, begins when a patient who has not paid for work hears another dentist criticize it. If you find pathology, simply explain your treatment recommendation to the patient, and then do it.

We are public servants doing difficult work, held to the highest standard. We should remember the words of Jesse Jackson, speaking before the Demo-cratic National Convention in 1984: "If in my high moments, I have done some good, offered some service...healed some wounds...then [my work] has not been in vain...If in my low moments...I have caused anyone discomfort, created pain...that was not my truest self...I am not a perfect servant. I am a public servant doing my best against the odds. As I develop and serve, be patient. God is not finished with me yet."

Patrick Wahl is an endodontist in private practice in Wilmington, DE. He is a legal consultant and serves on the faculty of the University of Pennsylva-nia. He lectures on practice management and endodontics, and can be reached by phone at 302-654-ENDO.

More in Professional Trends