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No One Told Me That
Sorry, this is a technical blog with a lot of ‘dentist speak’ in it, but others might be interested in the gist of it. Today, I saw a patient with a failing root treatment which they had done a couple of years ago. They had paid a lot of money, like hundreds of pounds, for this in a private setting. I usually try to let people down gently and warm the context before diving in with really bad news, so the first thing I said was "Well, root treatments are not a without their problems and there is an inherent failure rate". They asked me to expand on this concept so I went on to say “There is about an 85% prognosis for root treatment in this tooth, so I’m afraid you’ve probably fallen into the unlucky 15%!”. Their immediate and very grumpy answer was - “No one told me that”
Standards from all sources say that we should give patients choices. Further, in order for patients to give informed consent, we need to lay out the choices with risks as well as benefits, prognosis, and finally costs. It’s become standard practice to begin by saying “We could do nothing, but that means….blah, blah.” Then, listing the choices of treatments or materials and telling people why one costs more than the other. See the QCS Treatment Planning policy and Procedure for guidance on this.
What we are not very good at is telling patients how vulnerable or fragile these treatments are. It is like we are embarrassed about admitting that some things we do are not going to last forever. However, it is a brutal fact that they don’t, and unfortunately this is information that would be useful to patients.
Honesty pays off
Many patients actually wish to make decisions based on cost effectiveness. This means that some may choose the cheaper option for fillings, even if the life is shorter or the result not so aesthetically pleasing. On the other hand, some may choose to lose a tooth and have a nice implant replacement because we know that an implant has a better prognosis than an endodontic re-treatment.
Either way, people really appreciate honesty in the information we give. On one hand they are more likely to return when we give full disclosure. On the other hand, they are less likely to be grumpy if they find out later that the treatment they had was only going to last a few years. Nothing we do in dentistry can be taken as permanent.
Dr John Shapter – QCS Expert Dental Contributor