Who decides the final treatment rendered - the primary doctor, the specialist or the patient ?
The significance of the chief complaint can never be understated. While you may focus on a slightly discolored central incisor, and in your mind, complete its root canal treatment, prepare the tooth and deliver the crown; patient may be simply concerned that it juts out between the lips at rest. This vital communication is the first step in decision-making.
It is imperative that the medical and dental history is noted down in the maximum possible details, with the least possible questions put up. Ensure all details are in writing. It is the responsibility of the primary dentist to collect all possible records - study models, diagnostic images, diagnostic radiographs, wherever required, before opining anything about the treatment plan. For a missing tooth, an uncontrolled diabetic with a fluctuating blood pressure, will most likely benefit with a cast partial denture, instead of an implant supported teeth (Conditions apply), bridge or a flipper.
Once all the possible information required is with you, it is yours - the primary dentists’ duty to make time and sit with it, note the salient points and plan the treatment options. Patients who genuinely seek treatment, appreciate the fact that their doctor take time out to assess and analyse their case records and then come out with a detailed treatment plan. It is the ‘window shoppers’ who do not appreciate the efforts put in by you, in deciding the best treatment option for them.
IMPORTANT: If you spend material and time, in your pursuit of deciding the best treatment plan for your patient, you are within your rights to charge an amount worthy of the time & effort put in by you. Seeking a doctor’s opinion about a condition (to understand and treat which, he/she has trained for 5 years or more), is not the same as asking for the price of a washing machine from a salesperson at Shoppers’ Stop.
In your assessment of the case, if you feel, you will not be able to deliver the best possible results, without additional assistance, you must bring in a specialist, for the same. The role of the specialist may be limited to one particular part of the treatment. However, it is always in the best interests of the patient, that the case is discussed in totality, with the specialist.
Once you are sure of the sequence of treatment, it is in YOUR best interests, now, that you have treatment OPTIONS available for the patient, when possible. For e.g, in an uncontrolled diabetic with a fluctuating blood pressure, while your treatment options might be limited for a missing tooth replacement, in a healthy individual, you do have all the possible options working wonderfully well. For cases where there is just one option and the patient insists on having something other than that, you are within your rights to refuse treatment. If due to any reason, treatment has to be done as per the patient’s wishes, please do get a note signed from the patient stating that you performed the procedure contrary to the advice given and list the consequences of the same, on the note.
The treatment options have to be readied because there is a price attached to each, one or many of which, might not fit in the patient’s budget, or, the patient may choose not to spend that much amount for his dental treatment. (Refer to the Facts at start of the blog). You must have a Recommended treatment option and Other treatment option/s. Depending on the degree of involvement of the specialist, he/she may be present with you at the time of treatment plan discussion. Either way, you will be the anchor of the show, talking the most and getting in the specialist into the conversation when needed. There might be certain aspect of his/her treatment, which he/she may explain better. Once again, it is in your best interests that you have a list of pros and cons of each treatment option ready with. It will help the patient understand the reasons behind the Recommended treatment plan better.
As the primary dentist, it is your job to understand the case in totality, plan for additional help where required and present the treatment options to the patient. It finally comes down to the patient whether or not, he/she would want to go for your recommended treatment plan or not. Even if they chose the not-so-recommended treatment plan, do not be disheartened. The cons of the treatment you explained to them at the treatment start, once start manifesting, will keep them in awe of you, and they will eventually come back to the Recommended plan, which by now, would have involved further elements, which were non-existent at the time of the first clinical examination. You will end up taking up a bigger bite out of their pie.
The key lies in proper documentation, thorough case analysis, involvement of people who, where needed, can deliver better than you, informed consent, perfect treatment execution, a pleasant treatment experience and periodic post treatment follow up. Give it time and in due course, it will the four magical words that will come out of the patient, every time you present them the recommended treatment plan - “ As you say, Doctor!”