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Addressing problem areas with patients is never fun, but it is critical orthodontists have those conversations as soon as possible. By communicating early, you can help patients understand the potential for serious treatment problems and encourage them to accept suggested solutions. These conversations can also help minimize the risk of a malpractice claim or regulatory complaint. 

Examples of some potential problems would be development of root resorption, bone loss, or periodontal disease. If these issues are evident initially, the possible risks of treatment must be explained prior to starting treatment. Or, if these issues develop as treatment progresses, they must be discussed immediately with the patient or parent to avoid long-term consequences to the dentition.

If a patient presents with skeletal issues that would best be addressed with orthognathic surgery, you must have that discussion before beginning treatment. If conversations about this and the above issues are avoided, they not only can lead to a bad outcome, but also another dentist may point these issues out and be critical of the orthodontic treatment.

Following these general guidelines can help:

Develop a friendly, professional alliance. The orthodontist-patient relationship should invite questions and discussion with shared goals for treatment. An initial conversation outlining the treatment plan, as well as doctor and patient responsibilities, helps assure successful outcomes. It can also make a difficult conversation easier since potential problems have not yet been seen. You may be able to recommend a solution before an issue manifests or exacerbates.

Encourage discussion by asking permission. Remember, your expertise is critical, but you must engage patients so they will listen and understand. This is the whole basis of informed consent. You don't "give" informed consent, you "get" informed consent from the patient/parent by presenting the procedures, alternatives, and risks associated with the treatment you are going to provide. Many people “shut down” when told what to do. By asking permission to discuss the issue and explaining the treatment clearly, you are inviting the patient to become a part of the solution and take responsibility for the outcome.

Use your expertise to offer possible solutions when problems arise. It’s important to reassure the patient while being firm about methods for handling the problem. Discuss possible solutions and determine the next steps together. By trying to understand your patient and encouraging involvement, you are more likely to enlist cooperation for future treatment.

Document everything and consider terminating treatment when necessary. Some patients will not cooperate with treatment, which could result in serious damage to their teeth. It is important to pay attention and note when termination of treatment is the best option for the patient. Having good communication and giving appropriate notice may also mitigate the risk of malpractice allegations against you that could affect your career or reputation if a negative outcome occurs.

These guidelines may also be helpful when handling employee communication. Remember to discuss expectations at the onset whenever possible and encourage open conversation. Whether the difficult discussion is with a patient, parent, or employee, it is critical to document everything.

Learn how AAOIC can help!