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Refer, or not to refer?
In my work as an Expert Witness, I keep coming across situations where a colleague has continued treatment whilst a patient`s oral health has been deteriorating, or worse, ignored a situation in the hope that it might go away! Another common scenario is where a practitioner has diligently listed options for a patient, such as `leave with risks` and `extract`, but without including `refer to specialist`. A patient has the right to choice, which means we have the responsibility to inform (even if we don`t think they will take it up).
I`m sorry to start a posting with negativity, but this is about protecting yourself at the same time as helping a patient find the best solution. We need to take this aspect of practice seriously or risk our registration. Very early in the tenets of the GDC published `Standards for Dental Professionals`, is the paragraph –
“1.3 Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks. Refer patients for further treatment when it is necessary to do so.”
We all have those `Uh-oh` moments when things don`t go according to plan. You know, a file breaks off in the canal, or a root fractures during a difficult molar extraction and it`s so decayed elevators keep bring up rubbish and not the root. First of all, there is nothing wrong when that happens, it`s normal in practice for the unexpected to happen. The most important thing is how we deal with it. Responsible action after a disaster is more important than how it happened.
It might not be a specific incident though. Worsening periodontal indices, despite regular treatment, is a common path which can lead to complaint (or worse). There are situations when we need to recognise that a condition is outwith our skills and knowledge. On these occasions, our responsibility is to offer a referral to a Specialist or Practitioner with Special Interest. It can be a weight off your shoulders to do this too, especially if communication with a patient is breaking down.
It`s not an admission of failure, it`s not going to make you look incompetent. It will sometimes be relief on both sides. It will give the patient more choices which is always appreciated. So, go for it!
-Dr John Shapter