Joseph J. Massad, DDS
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Welcome back! This month's tip broaches one of the most irritating and dreaded realities confronting the dental profession on a daily basis – the possibility of being sued by a dissatisfied patient.
Eleven years ago, I engaged the legal assistance of both a defense and a plaintiff's attorney, and had two law professors review their remarks for accuracy. The aim of this endeavor was to define the dentists' legal parameters and, in turn, develop an understanding and a protocol to follow for all our patients. As of 2011, everything reported in my DVD and companion booklet has remained virtually unchanged.
In order to work in the least stressful environment possible, we need to develop a consistent method with every patient regardless of the procedure being performed. What follows is one question of the 20 in my DVD, followed by the response of the legal team. I have utilized many of their suggestions to treat the implant-over-denture patient with great success.
Question: Is a dentist responsible if an implant-retained removable prosthesis fails or isn't what the patient expected?
Answer: There's no such thing as a fool-proof procedure, and dentists shouldn't guarantee results. Some procedures fail, and the notion that a dentist can achieve desired results every time is more myth than reality. Dentists are, however, responsible if a procedure fails because they failed to meet the standard of care.
Simply consenting to treatment isn't good enough. Instead, a patient must give informed consent, which implies that he or she has been informed of the possible complications and anything that could possibly go wrong, including failure of the procedure. This isn't as easy as it seems.
After all, after boasting about how well a patient will function with a new implant prosthesis, it's extremely difficult for us, as dentists, to then tell that patient that the procedure might not work. None of us want to discourage a patient from undergoing treatment that has a high probability of success. And as we know, today's implant procedures boast some of the highest success rates of almost any procedure in dentistry.
So, how do we get around this? One option is to help patients understand, in no-nonsense terms, that it's our intent to do everything possible to give them what they deserve and desire. There are, however, certain instances in which patients don't respond well to treatment.
We explain that complications can and do occur, and it's our obligation to inform them of these possibilities. We also tell them that it's their right to either agree to treatment under these circumstances, or to decide against the suggested treatment.
In my experience, most patients understand that nothing in life is guaranteed. Even so, patients often forget what is merely told to them. Again, a signed informed consent has much more power than the spoken word. Without such a form, we may find ourselves fielding calls from stressed-out patients who are extremely upset and want their money back.
One situation that, if not handled well, could invite such calls is the need to change retentive elements, something that, despite an explanation, often falls on deaf ears. I explain that while the new prosthesis will provide the patient with much better retention, it still may not be what is expected. I further inform each patient that, if feasible, he or she can always have more implants placed for additional retention, if desired.
I am also careful to prepare my patients who receive only a mandibular over-denture with four implants (and not a maxillary prosthesis) that their maxillary prosthesis may not be as retentive as before they had the opposing implants placed, despite having no prior complaints.
The choices are to use a small amount of adhesive, have maxillary implants placed if possible, just live with it, or not have the lower implants placed. I discuss this in a very pleasant manner and help patients understand that in a perfect world we would have it all.
See you next month. I hope my pleasure in dentistry will also be yours ... Joe Massad.
Dr. Joseph Massad may be reached at (918) 749-5600 or at email@example.com.