By Dr Thomas McCaffrey, Dentolegal Consultant, Dental Protection
Teledentistry, while having been undertaken to some degree in the past, has never been more widespread than during the COVID-19 pandemic. When COVID-19 first started and dental practices stopped providing face-to-face care, teledentistry was one of the few mechanisms for providing advice of any kind to our patients. The provision of the AAA approach of advice, analgesia and antibiotics brought teledentistry into the realm of general dental practice.
As patients have become more used to technology assisting them with various meetings and appointments, patients may well still expect an element of teledentistry to be offered within the overall package of care that a practice can offer. It is important, however, to be aware of some of the pitfalls that can arise, particularly in relation to patient complaints.
Case study
Miss K, 34 years old, was a long-standing patient of the practice and initially rang the practice complaining of an abscess. Miss K was initially telephone triaged in the practice and advised that a dentist would call her back later that afternoon. Unfortunately, the message to contact Miss K was not passed on to her usual dentist and it was not until the following morning that a slightly irate Miss K rang back to ask to speak to a dentist.
Miss K’s usual dentist was not available on that day and the practice principal, Dr H, decided to call Miss K back straightaway to try to avoid any further complaints from Miss K, even though she had a considerable number of her own patients to deal with. Dr H reviewed the records and medical history, which showed that Miss K had no allergies, and she then rang Miss K. During the call Dr H apologised on behalf of the practice for the delay in responding. On speaking to Miss K, Dr H felt that antibiotics were appropriate and could be prescribed safely. Dr H prescribed amoxicillin and advised Miss K if the problem had not settled in 72 hours to call back and an appointment could be arranged.
Miss K started to take the antibiotics but became ill and was admitted to hospital with an allergic reaction to the antibiotics. Miss K subsequently made a complaint to the practice, asking how she could have been prescribed amoxicillin when she had clearly stated in her original medical history that she was allergic to penicillin.
Dr H contacted Dental Protection and, following a review of the records, it was clear that the medical history confirmed that there was no allergy and it had recently been signed by the patient. Unfortunately, other than a short note indicating amoxicillin was prescribed there were no notes of the consultation itself. On further review, however, it was discovered that the records Dr H had reviewed belonged to Miss K’s mother, who had the same address and telephone number. When Miss K’s records were reviewed, a penicillin allergy was noted in the medical history.
With the assistance of Dental Protection, a letter was drafted to Miss K apologising for the incident and providing reassurance that practice training would be implemented following this complaint. Miss K was happy that this should now not happen to anyone else and took the matter no further.
Learning points
- Ensure that you carefully identify any patient whom you consult with remotely and that the patient is aware which dentist has provided the advice.
- Even when a medical history is available, it is important to recheck this verbally during the remote consultation. If there is any doubt about the accuracy of the medical history, this must be clarified before any advice or prescription is given.
- Fully document the details of the telephone consultation, in the same way you would a face-to-face examination record.