The Tipping Point: I thought you knew…

There is a moment in every case where a disgruntled patient becomes a complainant. The Tipping Point is a series of cases and commentary that highlight that very moment.

Our patients believe us to be experts in what we do, and they rely on our clinical recommendations and treatment plans. But sometimes treatment can go wrong and, when that happens, our patients may lose trust in us. 

Case study

Miss L presented to Dr Y, seeking cosmetic treatment to address her congenitally missing upper lateral incisor. Her contralateral right incisor was a peg lateral. There were considerable discrepancies in tooth width and asymmetry in her smile. Treatment options were discussed, and Miss L consented to have porcelain veneers placed on the right lateral and the left canine, along with some minor gum surgery.

During the treatment the patient suddenly requested that the right central be adjusted. Dr Y thought that she wanted the tooth adjusted to create more space for the lateral veneer and did so. But Miss L became upset because she actually wanted her central shortened. This led to an additional and subsequent requirement to place bonded composite on the central.

The porcelain veneer on the left canine was cemented with the patient’s approval, and the composite was placed on the right side, thus necessitating another digital impression of the prepared right lateral to fabricate a new porcelain veneer. Mrs L, the patient’s mother in attendance that day, became very aggressive, saying that her son was a solicitor, and all treatment should now be free, due to the mistake made involving unnecessary tooth adjustment. Mrs L threatened legal action, saying that she would ruin Dr Y’s reputation.

Dr Y now felt very uncomfortable about finalising the treatment. She had a dilemma and decided to have the ceramist make the veneer and to inform Miss L that due to Mrs L’s intervention and threats, she would supply Miss L with the completed veneer, but Miss L would have to find another dentist to cement it.

Subsequently, Dr Y received a letter from AHPRA, seeking a copy of the records and a response to the complaint made by Miss L’s mother.

Commentary

Miss L had been happy with the original proposed treatment plan, which was presented very professionally and in a way that indicated the treatment was routine for Dr Y. Dr Y seemed confident and competent about the treatment she was suggesting. Miss L felt that Dr Y knew what she was doing and that she would act in her best interests. 

But her expectations of a good outcome were not realised.

The Tipping Point

So where did it all unravel?

Dr Y decided, after Mrs L’s intervention and threats, to cease treatment immediately and not to cement the porcelain veneer on the right lateral, preferring to inform Miss L that she would have to find another dentist to cement on the porcelain veneer. Miss L was dumbstruck and felt abandoned and helpless. She felt that she was a victim of the disagreement between Mrs L, her mother and Dr Y. She found herself not wanting to speak to her mother anymore. This was further exacerbated when the new porcelain veneer (cemented elsewhere) discoloured in a short time.

Outcome

AHPRA was critical of Dr Y for changing the treatment plan ‘on-the-run’. They expressed criticism that she had abandoned the patient so close to what would have been a successful completion of the case.

Learning points

Any change to the treatment plan mid-treatment should be thoroughly discussed with the patient before proceeding. 

It is never a good idea to abandon the patient in the middle of treatment, especially in an aesthetic case.