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ePaper created 2016-04-15, 11:34:57 | version 1.38.0
That is a very important aspect when writing expert reports on den- tal malpractice: did the dentist act to the best of his or her ability and according to the current knowledge orwithgrossnegligence?Thatiswhat makesthedifference. What can medical professionals do to protect themselves against legal disputes arising from high-risk proce- durestheyintendtoperform? Patientsshouldnotonlybewarned of the possible consequences of a certainprocedure,butalsobeadvised ofthealternatives—andoneofthose alternatives is not proceeding with treatment at all. In my opinion, the patient should always understand bothoptions:therisksofaparticular treatment and what could happen if nothingisdone.Onlythenshouldthe patientbeaskedtosignadeclaration ofconsent. Unfortunately, the reality is often quite different. Patients are often asked to sign declarations of consent on their way into surgery or while already on the dental chair. Even if theyhadquestionsthen,therewould be no time to answer them properly. Although it should be of major con- cern for every dentist to thoroughly informthepatientoftherisks,aswell as alternative treatment methods, before he or she is asked to sign a consent form, I am constantly con- frontedwiththeopposite. So, you are saying that consultation should be of similar importance to treatment? Absolutely. In my opinion, build- ing mutual trust between doctor and patient is key for avoiding mal- practiceandconsequentialcharges.If patients feel that their condition is being properly treated, and that money is not the dentist’s first con- cern,thisalonecanpreventlitigation in many cases. Of course, if a nerve is damaged, there needs to be a settle- ment of some kind, but if a bridge fails, for example, instead of filing charges the patient will return for further treatment if there is a solid, trust-basedrelationship. Time, communication, trust—what else is important when it comes to preventingmalpractice? One more basic rule every dentist should follow is adhering to evi- dence-based dentistry. This means not performing a certain treatment just because in the dentist’s experi- enceitisconsideredtoberight.Exter- nal scientific evidence should be im- plemented.Also,everysinglefinding shouldbetakenintoaccountindeter- mining how to treat the individual patient:diagnosis,radiographs,peri- odontal analyses, age, health status, literatureandsoon.Neglectingthese related aspects can very likely lead to misconduct. Doyouseebasicproblemsindentistry thatneedtochange? Nowadays, we face the problem of “cheap” dentistry. Owing to the amount of competition with the large number of dentists in the market, there are many cases of overtreatment. Cheap dentistry needs to be fast, yet I have docu- mented cases in which patients have returned for retreatment of a simple problem up to 70 times in two years. If you add up the time thosepatientsinvestonlytohavea poor outcome, it is striking. How- ever,itisnotpossiblefortheretobe elite dental practices solely. For le- gal purposes, dental treatment doesnotneedtobeexquisite,butit has to be reasonable. Maybe it is a problem of today that patientshaveincreasingexpectations regarding the service or technologies theirdentistshouldbeusing. That is certainly part of the same problem. Advertising that promises people a new Hollywood smile in 2 hours forms the basis of patients’ beliefs or expectations regarding treatment. Dentists should not be tempted to involve themselves in this kind of misguided pressure. Honest communication is key when aiming to avoid disappointing pa- tients. Measures to prevent malpractice should begin as early as possible, but whereshouldpreventionstart? Personally, I think legal regulation should be extended, such as specific laws or by-laws concerning the amount of experience and training, forexample,requiredinordertoper- form certain procedures. Basically, it is just what common sense calls for andeverybodywillagreewithifthey thinkaboutit:shouldonebeallowed to place an implant after attending aspeakers’cornertalkorlookingover acolleague’sshoulder?No,yetthisis oftenwhathappens. A second measure could focus on undergraduate education. Dental schools should devote more time to prevention of lawsuits. This aspect is neglected in the curriculum, al- though it is an essential part of dentistry. General awareness of the subject needs to be raised and this alonewouldhelppreventmistakes.As I said earlier, mistakes are not always avoidable,buttheyshouldatleastnot arise out of negligence, hubris or greed. Apart from that, there will al- waysbecasesofmedicalmalpractice. Dentistsarehumanstoo;onlyhewho doesnothingmakesnomistakesatall. Thank you very much for the inter- view. 09Dental TribuneAsia Pacific Edition | 9/2015 TRENDS&APPLICATIONS Bilateralmentalandlabialparaesthesiaina62-year-oldfemalepatientduetobilateralmandibularcanalperforation.(©DrAndyWolff) AD DTAP0915_08-09_Wolff 08.09.15 09:47 Seite 2 DTAP0915_08-09_Wolff 08.09.1509:47 Seite 2