When health care professionals feel their careers are at risk through any and all patient interactions, their practising profile changes. This results in an overall decrease in the quality of patient care for subsidised care (NHS, insurance) or an increase in cost for private care. Defensive dentistry results in:
- Some dentists will write great essays in the clinical notes, mentioning the slightest aspect of the patient interaction. This takes time – time that could be spent treating other patients. It also makes it difficult to see what treatment has actually been done because it is lost in a sea of batch numbers and pointless minutia.
- Private dentists find themselves having to write huge, multi-page treatment plans to explain the risk benefits of the treatment involved. This raises the cost of treatment for the patient because that time has to be paid for … no dentist should now be doing such for free in my opinion.
- Some dentists will avoid what they perceive as high-risk procedures (high-risk with regards litigation and regulatory complaint), referring patients on to an already overburdened secondary care system or on to well-respected private referral practices. This means patients either wait longer for their treatment (often getting trapped in a back and forth ping-pong between disenfranchised healthcare providers), or pay vastly more for treatment than perhaps they were expecting. It also de-skills the profession, which loses the ability to deal with treatment that dentists considered routine just fifteen years ago. This hits the most vulnerable, because the affluent, and those with the will, can be seen quickly via the private specialist network existing in the country. This is what happens when the population of a country embraces an adversarial, blame-led legal system. So perhaps there is some substance to the saying ‘A country gets the dentistry it deserves’.
- Dentists also start referring more with regards soft tissue lesions, due to the fear that they might ‘miss something’, swamping Max Fax departments in a deluge of biopsy requests, which means it becomes harder for genuine cases to be seen and diagnosed. Clinical intuition becomes drowned out by the fear of being negligent.
- It will likely go to the American extreme, where full-mouth radiographs become standard (absent from the other extreme, the worrying trend in many NHS practices, where supervised neglect is embraced due to time and cost issues), so as to ensure absolutely nothing is missed, irradiating the population above what is clinically necessary.
So, how is the patient served by a regulatory and litigation framework that promotes this? Until action is taken on those issues, dentistry in this country will not be the career is should be. Whilst we as individuals can change and adapt to combat the threats being hurled at us, only the government can fix this by radical overhaul of health care regulation and negligence law. The fact that they haven’t tells me they fund the present situation desirable.
Just a thought.