I look like a horse

When a patient makes a comment such as this, it can be difficult to know how to respond, but also figure out where it went wrong. Dr Annalene Weston, Dentolegal Consultant at Dental Protection, shares a case where the patient actually made this very accusation

Ms W, a social media influencer, did a great deal of research on achieving the exact smile she wanted. This research was largely within social media, as this is the space she understood and moved freely in. Dr B treated many reality show and sports starts for high-end cosmetic work, and they shared their successful aesthetic outcomes freely across their social media platforms. Ms W reviewed these cases, and other successful outcomes from Dr B’s social media profiles; based on this and his flexible payment plan options, Ms W scheduled an appointment for an assessment for veneers.

Dr B assessed Ms W and found that she had small square teeth, which he believed was the root cause of her dissatisfaction with her smile. He designed a smile in accordance with her request that her smile be “bigger” and showed her some of his successful cases who had had similar aesthetic requests. Ms W connected with the outcome of one of the ‘models’ and, although her smile design did not give her the same breadth of smile she was hoping for, she made some assumptions that her outcome would be exactly the same.

Ms W booked in as quickly as she could and tolerated the temporaries, which she hated. She requested no changes be made to the final shape and size of the teeth, despite encouragement from Dr B to speak up about any concerns she may have. She did not understand that the temporaries were a replica of her final outcome. This disconnect between the two of them continued, with Ms W focused on what she thought she was getting, and Dr B making the assumption that ‘silence equals consent’. 

After cementation Ms W was devastated by her appearance. She found the teeth too long, and they affected her speech. She was also experiencing pain. Dr B’s practice made several calls to invite her in for a follow-up to check on her, which she ignored because she was upset and embarrassed and no longer trusted Dr B. With the passage of time, the tone of these calls changed to chase up the outstanding account. Ms W became withdrawn, and her feelings about her teeth impacted her ability to work, socialise and leave the house. She did not want to pay for the work because she hated it. This was compounded by the fact she was in pain. As the calls and letters from the practice continued to come thick and fast, Ms W Googled her options, as she felt she needed to act to make it all stop.

Dr B received a statement of claim, which is a document telling him he is being sued by Ms W, on the grounds that he provided treatment to her without her consent. A review of his records quickly revealed that there was no documentation regarding the conversation of consent, and that Ms W had not signed her standardised consent form. Things got worse from there for Dr B, as all of his records were skinny at best, and, consequently made it incredibly difficult for him to form a defence.

The matter was settled out of court.

Learning points

• Don’t rush into elective cosmetic treatment without first ensuring you understand your patient’s needs. 

• Ensure that all conversations with patients are documented in your clinical records.