This article on jousting in dentistry by MLMIC’s Al Anthony Mercado, Esq., and Linda Pajonas was originally printed in our Fourth Quarter 2022 issue of The Scope: Dental Edition. Read more articles from the publication here.
The term “jousting” may invoke images of Camelot and chivalrous knights in shining armor. Unfortunately, jousting in the dental arena is anything but a fairytale. Jousting amongst dentists has been shown to be a contributing cause of patient dissatisfaction and malpractice claims. This article will explore jousting in dentistry, discuss its negative impacts and provide practical guidance to avoid it.
What is jousting?
Jousting in dentistry refers to comments made by one dentist about the treatment and/or result of another dentist that are intended to be critical or that a patient can perceive as being critical. In general, jousting can include verbal and written comments. These may include intentionally criticizing the care of other dentists; second-guessing the plan of care of another dentist; making entries in the dental chart disparaging another dentist’s treatment; and writing “To whom it may concern” letters written for a patient explaining why dental work needed to be redone.
Sometimes a comment is not intended to be a criticism but can be perceived as such by the patient. These comments may include “Who did this to you?” or “Why did the other dentist do or not do something?” In this scenario, demeanor and context play a role in whether the patient translates a comment about another’s work into “somebody did something wrong.” Accordingly, care should be taken when commenting about another dentist’s treatment so as not to imply that you are being critical.
Jousting is commonly seen in situations involving a second opinion, a referral to a specialist, or subsequent treatment. Data has shown that jousting is most noted in cases involving restoration, implants and crowns.
The relationship between jousting, patient dissatisfaction and malpractice claims
Critical comments can validate patient dissatisfaction, plant a seed that something was done wrong and eventually lead to a malpractice claim. Cases involving jousting have been shown to be outpacing other types of malpractice cases year after year. Data has shown that jousting cases account for 15% of all cases and 16% of total dollars paid out. Similarly, cases involving jousting and documentation issues have been shown to be 18% more expensive to resolve than the average of all other cases.
In essence, the critical comments that constitute jousting can make it easier for the malpractice attorney to prove their case. The criticizing dentist will likely have their chart requested and be subpoenaed for a deposition and, possibly, for trial. Under oath, the critical comments will be explored in exhausting detail and used in the prosecution of the malpractice case.
The ethical considerations of jousting
The American Dental Association’s Principles of Ethics and Code of Professional Conduct provides, in pertinent part, “Patients should be informed of their present oral health status without disparaging comment about prior services. Dentists issuing a public statement with respect to the profession shall have a reasonable basis to believe that the comments made are true.”
Similarly, The Principles of Ethics and the Professional Code of Conduct of the New York State Dental Association provide, in pertinent part, “A dentist should exercise care that comments about a prior dentist are truthful, informed and justified, and this might include consulting with the prior dentist to discuss the circumstances and conditions under which treatment was performed.”
Accordingly, it is abundantly clear that comments, whether verbal or written about another dentist’s treatment, must be truthful, informed, justified and non-disparaging. Dentists should understand that patients have access to their dental chart, and critical comments made in the chart can violate the above ethical provisions.
The question arises whether a dentist can or should comment about work done by another dentist. The general answer is “yes,” subject to the ethical provisions set forth above. In fact, dentists have an ethical obligation to inform patients of their findings. These findings should be communicated in an informed factual manner that avoids finger-pointing and disparaging comments. As a final matter, though, while there is nothing in the ethical code that obligates a dentist to comment upon or critique another dentist’s treatment, dentists are required to report instances of gross negligence to the appropriate governmental agency.
Practical guidance to avoid jousting in dentistry
It is important that a subsequent treating dentist get the whole story. In addition to your findings and what the patient has said, get the patient’s permission and communicate with the other dentist to determine the circumstances surrounding the treatment. This can include a review of previous dental records and films. You may learn that the patient was noncompliant or that the dentist was not involved in that aspect of the treatment.
Communicate your findings to the patient in a factual manner. Since you did not participate in the other treatment, discuss your findings and potential treatment plan with the patient. Exercise care that comments about other dental treatment are factual, truthful and justifiable. Document your findings and communications in the dental chart objectively.
In general, differences in opinion or preferred treatment do not necessarily indicate poor treatment. Exercise care in discussing “what you would have done differently” so as not to imply that something was done wrong, or a better result could have been possible.
Refrain from writing “to whom it may concern” letters that intentionally or unintentionally criticize another dentist’s treatment. It should be noted that there is no confidentiality in such letters, or the comments contained therein. Therefore, these letters can be used as the foundation for malpractice claims and reports to governmental agencies. Keep in mind that any critical comments that are not truthful or justified can result in an ethical violation against the dentist author. In addition, the dentist author can also be questioned at a deposition about the veracity and accuracy of such comments.
Patients are dependent on the dental profession to provide them with factual and substantiated information about their oral health status. Jousting in dentistry helps neither patients nor the dental profession. In fact, by its definition, jousting is destructive to patient faith in the dental profession, as well as being a contributing factor to encouraging malpractice claims. Dentists should refrain from the temptation to unjustly criticize another dentist’s treatment and leave jousting back in medieval times.
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