In an effort to continue to provide relevant risk management case studies to readers, we will be providing a high-level overview with links to the full case studies, which are often too lengthy. Our partners at MedPro Group offer “best in class” risk management resources on a wide variety of topics; I strongly encourage every practicing dentist to incorporate these materials into their regular “team huddles” as part of an ongoing commitment to building a culture of continual learning within their practices. Visit Medpro.com for materials. Our topic this month is how to maintain professional boundaries when treating personal friends in your practice. The full case study is available at https://medprodental.com/case-study/when-personal-relationships-affect-professional-care.
It is a common misconception that patients who are personally close with a dentist will never sue the dentist. Many dentists establish longstanding friendships with their patients. While such relationships may better both of their lives socially, they may also provide for a feeling of being uncomfortable when the dentist believes that a serious discussion is needed if the patient does not follow proper home care, does not regularly present for dental visits, does not abide by the dentist’s advice, or does not pay bills.
Retirement does not close the door on possible lawsuits. At a dentist’s retirement party, he suggested that a longtime friend/patient visit the young dentist who had purchased his practice, and she did so just a month later. At that visit, the new dentist took a full mouth series of radiographs, did a tooth-by-tooth assessment, and performed a cancer screening by viewing and palpating all of the tissues, intra- and extra-orally, after which the patient remarked that she had never had such an examination before. The examination revealed the presence of a large eroded and indurated lesion on the right lateral border of the tongue, as well as an enlarged lymph node in the right neck. She was immediately referred to an ENT, who conducted a work-up that diagnosed a squamous cell carcinoma of the tongue; staging protocols determined that she had stage III cancer. Despite her many years of friendship with the dentist, the patient sought legal counsel, encouraged by family members.
The retired dentist was sued for failing to diagnose the patient’s squamous cell carcinoma, thereby causing her to undergo life-altering treatments, negatively affecting her quality of life, and decreasing her life expectancy. With the dentist’s consent, the case was settled within policy limits. The dentist subsequently attended the wedding of the patient’s daughter.
Unfortunately, it is all too frequent that patients become aware of previously undiagnosed conditions or improprieties in their prior dental care, only when they leave the care of one dentist in favor of another. While the “new” dentist has a clear obligation to inform the patient of what is found upon examination, the way that such information is imparted may mean the difference between the prior dentist being named in a lawsuit or not. Professional communication is a vital risk management tool.
In conclusion; from a risk management perspective, all patients, regardless of status, ought to be treated dentally in the same way, in accordance with the appropriate standards of care. As this case demonstrates, personal and professional relationships can and should be kept separate.