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Sledgehead

Advise me : Third Party Dentistry Procedures

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I'm helping my elderly Mum with organizing her dental treatment.

Because of medical complications, she sought a second opinion from a collective of independent specialists.

The surgeon she saw said he would be happy to undertake work (extractions) , but only as part of an overarching treatment plan (which included dentures). The treatment plan would need to specify the extent of the work, including surgical procedures, and be drafted by a general dentist.

Her general dentist then drafted the treatment plan. He agreed to liaise with the surgeon about his plans.

Everything seemed fine.

PROBLEM

Mum was then asked to get a date, time, description of works and costing from the surgeon by the gen dentist. When she received this, it became clear that, despite both insisting they had communicated, their view on the extent of work differed markedly.

Clearly, Mum can point out the discrepancy, and get them both to agree the treatment plan. But is it that simple?

IMPLICATIONS

My worry is that this technical miscommunication is an early symptom of a fundamental flaw in the three cornered relationship between Mum, her general dentist and the independent surgeon.

I pondered this and concluded the relationship as it stands is akin to her being a project manager. She has two contractors, whose work must mesh; rather like a builder and a glazier. Obviously, getting them to talk directly should result in success, but if the windows don't match who is really responsible? The builder? The glazier? If neither is formally the subcontractor of the other, my guess is it's the project manager's fault.

And that's my worry here.

Normally people are referred for second opinions or specialist work. That didn't happen here. Both dentist and surgeon are my Mum's 'contractors'.

If she was employing glaziers and builders, I'd gladly set up a protocol for making sure all parties were on the ball. I'm not at all sure I should be doing this for dentists and surgeons. I understand their current miscommunication, but who knows how technical things might become down the line.

YOUR VIEWS

My current thinking is to get the dentist to subcontract the specialist along the lines of normal referral arrangements. That way the dentist would be entirely responsible for the finished job.

It's either that or possibly act as a conduit between the parties so I know exactly what they are saying to each other. But then I'm guessing I may be liable for how good or bad the finished job is.

Thoughts. Please.

 

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Is your mum using a private dentist?  Because if it was an NHS dental practice, it would be normal practice to refer to an oral surgeon or surgical dentist specialist for the extractions. This would form part of one treatment plan, which would be undertaken jointly; extractions by the oral surgeon and further denture work by the GDP. 

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3 minutes ago, Bossybabe said:

Is your mum using a private dentist?  Because if it was an NHS dental practice, it would be normal practice to refer to an oral surgeon or surgical dentist specialist for the extractions. This would form part of one treatment plan, which would be undertaken jointly; extractions by the oral surgeon and further denture work by the GDP. 

No, tis all private.

Only private money can get you in to problems like this! :D

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Yes, true. But the dearth of NHS dentists does force the issue. 

Remember, each practitioner is required to answer for his or her own clinical practice. Patients, or their relatives can complain direct to the General Dental Council. Complaints

Oral Surgeon will/should hold dual basic dental and medical degrees, plus a Specialist training certificate in Oral Surgery. 

 

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Quote

The surgeon she saw said he would be happy to undertake work (extractions) , but only as part of an overarching treatment plan (which included dentures).

The treatment plan would need to specify the extent of the work, including surgical procedures, and be drafted by a general dentist.

Her general dentist then drafted the treatment plan. He agreed to liaise with the surgeon about his plans.

--

This is the oddity. The surgeon clearly has their own views about what needs to be done, but didn't communicate that to the dentist who then created an itinerary of what ought to be done. You'd have thought that the person doing the work - and getting paid - the surgeon - would come up with the plan.

Indeed it appears that they have done so, given that it differs from the dentist's view. Both have "plans". So why is the original dentist even involved?

In effect your mum is the Project Manager. Which is far from ideal because your mum is not a qualified dental practitioner.

It sounds like the surgeon is going to be doing all of the work. The only role for the dentist is to draft the plan. Since the surgeon is the one tasked with the work then he or she is the one who should determine what ought to be done.

And that your mum should book in a little time with her dentist to query the discrepancy. I suggest the dentist since they are presumably cheaper than the surgeon. And they drafted the plan, apparently, on the instruction of and at the insistence of the surgeon.

Ask for an explanation of the differences in suggested treatments. It may be simpler than you imagine and explainable. It may also be related to borderline condition of some teeth and differences of opinion as to how long they will last.

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2 minutes ago, Bossybabe said:

Yes, true. But the dearth of NHS dentists does force the issue. 

Remember, each practitioner is required to answer for his or her own clinical practice. Patients, or their relatives can complain direct to the General Dental Council. Complaints

Oral Surgeon will/should hold dual basic dental and medical degrees, plus a Specialist training certificate in Oral Surgery. 

 

I hear you.

My concern is not one of the professionals' competence or indeed whether their work is good or not, but rather how that work comes together.

So the dentist might deliver great dentures. And the surgeon might extract w/o complication and healing problems. But that is no different from a glazier making a great sealed unit and the builder making a sound structure, only for the windows not to fit!

So my concern is that the fit may not be great. Who would then be responsible?

As it stands, the dentist is making dentures 8 teeth long whilst the surgeon thinks only 6 teeth need be removed - and these guys have supposedly communicated!

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3 minutes ago, DTMark said:

The treatment plan would need to specify the extent of the work, including surgical procedures, and be drafted by a general dentist.

Right. And I know we all agree on this.

My worry is there has already been a gross miscommunication, and liability in the relationship is, as far as I can see, unclear.

If this were a normal client / proj manager / contractor / subcontractor relationship, I'd know what to insist on, but this whole ad hoc technical relationship between professional medic types is throwing me.

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1 minute ago, Sledgehead said:

I hear you.

My concern is not one of the professionals' competence or indeed whether their work is good or not, but rather how that work comes together.

So the dentist might deliver great dentures. And the surgeon might extract w/o complication and healing problems. But that is no different from a glazier making a great sealed unit and the builder making a sound structure, only for the windows not to fit!

So my concern is that the fit may not be great. Who would then be responsible?

As it stands, the dentist is making dentures 8 teeth long whilst the surgeon thinks only 6 teeth need be removed - and these guys have supposedly communicated!

That makes more sense. Well, in terms of what's happening.. Ask the dentist bluntly what dentures need to be made and fitted.

If he or she insists it's for 8 teeth, and that's what's needed, then explain that is not what the surgeon is going to be prepping for. As he or she now knows. So there's little point in continuing to make dentures that aren't going to fit.

Ask if you should you seek out another surgeon who will do the required prep work and see what the response is.

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1 minute ago, DTMark said:

That makes more sense. Well, in terms of what's happening.. Ask the dentist bluntly what dentures need to be made and fitted.

If he or she insists it's for 8 teeth, and that's what's needed, then explain that is not what the surgeon is going to be prepping for. As he or she now knows. So there's little point in continuing to make dentures that aren't going to fit.

Ask if you should you seek out another surgeon who will do the required prep work and see what the response is.

I don't see any need to seek out another surgeon. The guy described himself, self-deprecatingly as 'monkey' to the general dentist 'organ grinder'. He will do whatever he is told.

Unfortunately somewhere along the line wires have crossed or something, and the surgeon thinks the job is different from that laid out in the treatment plan. I've seen the plan and I can see the surgeon has got things wrong. So either the dentist hasn't sent him the plan in an intelligible format, or he just read it wrong. Either way, a miscommunication is apparent. And I'm not sure I want my Mum to be liable for ensuring they are correctly communicating.

Hence my thoughts on moving the arrangement to a formal referral.

If that can be done.

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Yes, it can be done and while noting your point

3 hours ago, Sledgehead said:

My concern is not one of the professionals' competence or indeed whether their work is good or not, but rather how that work comes together.

I suggest you should be concerned as if they are unable to liaise over what they propose to do then they are incompetent, albeit not in a way that immediately produces fear when poking around in Mum's mouth with sharp instruments.

Either, ask general dentist to start again with treatment plan and confirm he and the surgeon are both signed off on this OR change general dentist and start the process again.

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17 minutes ago, Boomer Baby said:

Yes, it can be done and while noting your point

I suggest you should be concerned as if they are unable to liaise over what they propose to do then they are incompetent, albeit not in a way that immediately produces fear when poking around in Mum's mouth with sharp instruments.

Either, ask general dentist to start again with treatment plan and confirm he and the surgeon are both signed off on this OR change general dentist and start the process again.

Your local dental helpline should be able to put you in touch with an NHS dentist. Find them through NHS choices. 

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57 minutes ago, Boomer Baby said:

Yes, it can be done and while noting your point

I suggest you should be concerned as if they are unable to liaise over what they propose to do then they are incompetent, albeit not in a way that immediately produces fear when poking around in Mum's mouth with sharp instruments.

Either, ask general dentist to start again with treatment plan and confirm he and the surgeon are both signed off on this OR change general dentist and start the process again.

Thanks, as with all who are contributing.

Take all of your points and have dispatched a letter demanding to know lines of responsibility and insisting on clear communication between all parties.

Mum took this to her appointment, and besides a bit of flannel wrt my letter writing skills, he also spent ages on the phone trying to get hold of Mum's particular surgeon. In the end he talked to the head of the specialist centre. Mum's surgeon seems a bit over-booked (in demand?) so was unavailable during the appointment. She did however receive reassurances that he would be brought on side. I will be making sure this is the case.

The picture I now have is that the surgeon is responsible for the extractions (including healing) and that the general dentist will take responsibility for the dentures including their fit. The general dentist offered to be present at the extraction if Mum felt that necessary. Can't honestly see the point in that.

I'm supposing I should be happy with this.

Has anyone else noticed the ad hoc, laissez-faire attitude to contractual obligation and its documentation that seems to pervade dentistry and private medicine? Sure, they'll talk you through things as and when you ask, but getting bits of paper off of them promising things isn't something they do as a matter of course. I suppose some of this has its roots in the nhs, and some in the fact that they can't promise outcomes. On the other hand, all customers want are promises of practice and procedures. Is that really too much to ask for?

Getting a list of costs and procedures for Mum's work was, well, not as difficult as pulling teeth, but it wasn't automatic, and I'm sure you can appreciate my wish to exploit the pun!

I get the impression the dentist would have been happy to drip-drip the bills w/o explicit reason or warning. Heavens knows how those strapped for cash would cope. I guess they think: here's another coming, softly softly, catchy monkey!

 

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2 hours ago, Bossybabe said:

Your local dental helpline should be able to put you in touch with an NHS dentist. Find them through NHS choices. 

Malheuresement, Mum has had an unhappy experience with an nhs dentist. I have pointed out she has had similar experiences going private (and more so). On the other hand, I too have had an unhappy dental experience on the singular time I used an nhs dentist. I had a cracked filling I wanted repairing so rocked up on spec. She filled the wrong tooth!

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3 hours ago, Sledgehead said:

Malheuresement, Mum has had an unhappy experience with an nhs dentist. I have pointed out she has had similar experiences going private (and more so). On the other hand, I too have had an unhappy dental experience on the singular time I used an nhs dentist. I had a cracked filling I wanted repairing so rocked up on spec. She filled the wrong tooth!

I'm lucky in that I work in a practice that's part of an NHS trust. It has a high reputation in the area. See if there's a similar setup of 'community dental services' on your local trust web site. They'll be better run than most NHS GDP's. 

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57 minutes ago, Bossybabe said:

I'm lucky in that I work in a practice that's part of an NHS trust. It has a high reputation in the area. See if there's a similar setup of 'community dental services' on your local trust web site. They'll be better run than most NHS GDP's. 

Thanks for the tip. Word from the wise 'n all. Can't beat that. I'll check that out, if not for Mum, then for myself. Nics gotta be worth something, right? I come from a long line of folks who insist on paying for stuff that's free. But stuff like in-work-benefits and, more significantly, freebies for those who are more than comfortable (not to mention tax avoidance schemes) is making me wonder how insane I need to be to carry on that family tradition.

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