I am thoroughly ashamed. I have struggled to resist seeking solace from psychological props like alcohol or drugs, for many years, but I’ve recently realised that I am, in fact…an addict! I’ve become totally addicted to dental groups on Facebook.
At some point during your professional career you will no doubt have been faced with an unpleasant patient; you may have been unlucky enough to come across a few. However, in what circumstances can you refuse to treat them?
Alternatively, what if a patient refuses to be treated by you or someone in your practice? What if the reasons for such a request are or could be discriminatory?
At a time when instances of every day discrimination and sexism are rife in all walks of life, it is not hard to see why some dentists and doctors feel like they are walking on egg shells. This week BBC Radio 4 Today Show presenter John Humphrys, asked the tennis player Johanna Konta a series of questions regarding her origin, culminating in, ‘So, what are you?’; questioning whether she was truly British. Johanna Konta has represented Great Britain at the Olympics and the Fed Cup. She has been a UK citizen for almost half her life. Chancellor Philip Hammond, has been criticised for allegedly saying driving a train is so easy 'even a woman can do it'. We’ve even seen uproar over the “sex” of a fictional character with two hearts.
But is there ever a situation where someone’s nationality or sex can affect their ability to perform their role?
Refusing to treat a patient
With so much regulation in place and a fear of patient complaints being escalated to the GDC, you may feel as if patients hold all the power. However, there are situations when you are entitled to refuse to treat a patient. Below are 6 legitimate reasons for refusing to provide treatment:
1. When a patient questions your clinical judgment. If a patient questions your clinical judgment or expresses a lack of confidence in your abilities, we would recommend you stop treatment immediately. At this point explain to the patient that it is important they have confidence in you as their treating physician and that to carry on treating them would be unethical. Try not to take this personally, and certainly avoid arguing the toss with the patient; this could result in a complaint against you. Everyone has different views and personalities and whilst you and the patient may clash, there will no doubt be another dentist who gels with the patient.
2. When there has been an ‘act of God’. If a dentist is hospitalised or suspended, or there is an emergency, such as a flood in your practice, it will be impossible for you treat the patient at that time. Keep the patient updated and make alternative arrangements where possible, otherwise the patient may go elsewhere.
3. When a patient fails to pay a bill or continuously misses appointments. If a patient fails to pay bills or continuously misses appointments, then you should give them a warning that this conduct will not be accepted and future similar conduct will result in them being removed from the Practice. Put information on your website regarding the circumstances in which treatment may be withdrawn.
4. When there is a conflict of interest. Whilst, this is unlikely to arise that often in a dental practice, there may be circumstances, for example where a patient is pursuing a claim against your colleague, where it would not be appropriate for you to treat. If the patient comes to you and you know about the claim, there could be a perceived conflict and it would be better not to treat the patient at all. However, if you are part way through treatment, you should highlight to the patient that you are aware of a potential conflict and let the patient decide whether they wish for you to continue treatment.
5. When a patient is violent or abusive. If a patient is violent, or even threatens violence, to you or any of your staff, depending on how serious this is you may wish to call the police. In terms of treating the patient in the future, you should assess the situation and why the matter escalated. For example, was it honest misunderstanding that has got out of control, or has the patient been violent for no reason? Do you think the patient can be managed in the future without putting your staff members at risk. The more serious the incident the more justification you will have for refusing treatment. Write to the patient and confirm that you will no longer be treating them and, if you are an NHS practice, contact the NHS Commissioning Board.
6. When a patient has complained. You should avoid the temptation to refuse treatment in these circumstances as it could result in a further complaint. However, if the complaint is about your clinical treatment or is shown to be entirely unjustified or malicious you can follow the process in point 1 above.
Patient’s freedom of choice
Generally speaking, a patient has the right to choose which dentist provides them with treatment, just as you are entitled to choose who supplies your materials for your practice. Therefore if a patient requests a specific dentist to provide treatment you should seek to accommodate that request.
What if the request to be treated by a specific dentist is racially motivated? You have no obligation to treat a patient in those circumstances except in an emergency. Bear in mind, the patient also has to consent to treatment, and they can refuse treatment on bigotry grounds if they wish.
However, there is a grey area in all this. What if a female patient requests a female dentist on religious grounds? Or a Polish patient requests a Polish dentist as a result of not speaking English? In these circumstances, we would recommend accommodating such requests where possible, to prevent allegations of discrimination against you.
You should create a practice policy for dealing with such requests so staff know what to do and can identify when such requests might be reasonable.
If you need advice or assistance in dealing with a difficult patient, you can contact Laura Pearce on 0207 388 1658 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it..
Laura Pearce, Senior Solicitor
thanks
As the autumnal fall returns once again and the ominous portent of a Comet Ison[1] in the morning sky passes I am minded to wonder at our innate ability to disagree. There is a really intriguing book out there called Them and Us: How Neanderthal predation created modern humans by Danny Vendramini [2] Basically, our behaviour is nothing new!
The BDA saga has not gone away, we are told – well, actually we are NOT told … but the vox pop of internet chat suggest that those in office at the BDA are running in internal disagreement, and of course all the outsiders like myself are far better placed to run the show. There is no agreement it seems, and we are polarised into them and us.
Then of course there is how to deal with ‘the problem patient’. Not only do we all differ, separating into the “This is how to do it” camp on the one hand, and the “No you fool, do it this way” camp on the other. Never mind that the poor bloody patient is always wrong. Them is always right and Us is never wrong.
Orthodontics appears to be generating a fair share of divisionary comment: Far from everyone synergising to the wider benefit of the patient community and for the greater good, we just have to bicker and squabble over long term or short term, GDP or specialist , ultra modern self ligating or out of date elastics. Throw in a spooful of commercial self interest and the fuse is lit for a right royal bust up.
What would the public think? Oh – them and us again!
There is a fine line between appropriate professional disagreement and internecine warfare. We must as a profession beware of breaching it ... if we actually care. Maybe we just like a good fight!
Gawd ‘elp the poor old GDPs if the BDA and BOS combine forces …
Seriously: who will draw this disparate medley of headstrong prima donnae professionals together?
If we fight amongst ourselves, the Governments work is done.
Ah … now there is the Ultimate “Them and Us”.
I blame Comet Ison. Enjoy Thanksgiving, don't all fight over the Turkey now. That would far too Neanderthal ...
[1] http://www.bbc.co.uk/news/science-environment-25001732
[2] http://www.themandus.org/
Them and Us by Danny Vendramini
With acknowledgement to the author for the image
