Responsibility for incomplete implant cases?
Here it is the end of the year, and I go through some old charts of unfinished cases. Every year I have cases where I placed a single or multiple implants and the patient never returns for suture removal, healing check and restoration. I send them letters, regular US postage first class. Many of the times the mail is returned unable to forward or whatever it is they call it. What is my responsibility to track them down?
8 Comments on Responsibility for incomplete implant cases?
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Carlos Boudet, DDS DICOI
12/21/2018
We don't have that problem with implant cases. for comprehensive dentistry, we make three attempts and document them. the last one by certified mail. If it is returned, we save it in the patient's chart.
mark
12/21/2018
I would like to believe we are all comprehensive in that we want to finish their dental care and do what is best for the patient. Similarly, we all keep copies of this sort of thing in the chart. I guess you are right in that certified mail is the standard of care for follow through. My question is for those letters returned with no forwarding address, why would I send a certified letter and have it returned? Now that we have more than the post office, should I google these patients and try to do a search? I can't argue with your answer in that a certified letter is a reasonable attempt to follow the standard of care even if it will not result in that letter being delivered in some cases.
Richard Hughes, DDS
12/21/2018
Send one letter each, certified and regular mail. If no response, call it a day. Make copies, especially the return receipt and place them in the patients chart.
The patient has a responsibility to themselves. We should not act like their parents.
Timothy C Carter
12/21/2018
I was taught in residency that we should not have to remind a patient of their responsibility to return. I don’t think you need to worry about liability. To simplify it though I always use Chromic gut suture ( unless there is a good reason not too)and thus removal is not an issue
Bruce
12/21/2018
All you have to do is make a reasonable attempt to contact. You don't have to be the FBI. Document a phone call to the last number, email if you have it, and a letter first. If returned with no forwarding address, no need to send one certified to the same address as it will be returned. If the first one goes out and no response and no return, you can send one tracked by any method to confirm delivery to the address (registered, certified or tracked). All have proof of delivery and you're done.
Dr. Gerald Rudick
12/23/2018
Dentists who are involved with implant dentistry are a special breed of dental professionals.....they go far beyond what is considered the standard of care......everyone wants to see their cases completed......however, an equal part of the responsibility of having implant cases completed lies with the patient.
It should be fully documented and part of the patient's consent form that they must give their dentist information of change of address or contact information, and must inform the dentist if they are not going to return for the prosthetic part of the treatment.
Unfortunately there is a certain element of people who feel they can make a good living by going after the dentist with a malpractice suit and claim money for damages; and/ or lodge a disciplinary complaint against a dentist to bolster their financial case by going to the licensing body and making a complaint there. Unfortunately, many of the people who work for the licensing bodies are professionals who work for the licencing bodies because they could not survive in private dental practice, and now they have all this power at their disposal and what better way is there to get back at people who are successful and they are jealous of...…. this is the disgusting part of our profession, and it goes on in every part of the free world.
So the message here is try to maintain good relations with the patients, explain and document what you have told to the patient, and have good witnesses or video to back up these explanations. If you see your future patient has some personality disorders....stay away no matter how terrific this case might be in your hands....STAY AWAY!!!!!
Dr. Moe
12/24/2018
Dr. Rudick,
I am in total agreement with your points. I remember stating to my attendings during residency numerous times, “I never knew becoming a dentist meant I am the only adult in the room. As if patient has no responsibility in a failure due to non compliance or not returning for follow up visits and treatment completion”. They all agreed to that point and we all scoffed but sadly that seems to be the norm. I think we as professionals need to come up with a coherent, real life examples to show the licensing bodies that successfully delivering a treatment sometimes is more dependent on the patient, and that if the professional has done a good job in most cases then in a case of contention, maybe, just maybe, the responsibility lies with the patient as well.
Anyway, I am sure I am preaching to the choir. And I do, as I am sure, all others here do as well, try to maintain good relationships with most of my patients. And documents, document, document. And the funny, and sad thing is I have thought about putting a video camera in my rooms to document every option and it’s Pros/cons/limitations/complications that I discuss with my patients. Disgusting, indeed!
LSDDDS
12/23/2018
REMUNERATION NOT WORTH AGGRAVATION
