Opinion Piece

The Respectful Treatment Plan

Drs Ramesh Balasubramaniam, Lalima Tiwari, Amanda Phoon Nguyen, Alissa Jacobs, Jacinta Vu

Oral Medicine Specialists

Dentistry has often enjoyed the benefits of being a tight-knit community. Many of us know each other, or know of each other, whether it be through dental school, through CPD, dental functions, or through associations such as ADAWA. This especially holds true when it comes to patient care and the relationships formed between dentists, other oral health care professionals and specialists.

Dentists choosing to refer a patient to another colleague should always be afforded respect. After all, the referring dentist and patient always have a choice, and will ultimately choose, in their mind, “the best” specialist in Western Australia for this patient, to refer to. This characterisation of “the best” is rightfully based on mutual respect, trust, accessibility and ultimately, likability. instances where the patient has understood perfectly, but the delivery of the specialist treatment plan has left the patient angry.

We have all been there. That is, when a case did not go to plan; whether it be a suboptimal result or a “stuff up” that requires specialist assessment and “fixing”. Regardless, when the patient is referred, the referrer deserves the benefit of the doubt and respect. With a

Unfortunately, there may be some instances where the patient has understood perfectly, but the delivery of the specialist treatment plan has left the patient angry.

There have unfortunately been a few instances of dental colleagues complaining that their specialist colleague has “dissed” their treatment plan to their patient. It should be noted though, that the Dental Board of Australia states that dentists (general and specialist) are entitled to carry out all aspects of dental care, even if it falls within the scope of dental specialist practice, as long as the dentist believes they have had adequate training and/or experience to carry out the procedure. Of course, dentists (general and specialist) have a duty of care to do the best for their patients. That means, in some circumstances, we will be faced with the decision to acknowledge our limitation (that we don’t know everything, and that we can’t know everything) and hence have to refer our patients to another dentist (general or specialist) to fulfill the patient’s dental needs.

As anticipated, the person to whom the patient has been referred will assess the patient, establish the diagnosis, and formulate the treatment plan. This treatment plan must then be discussed with the patient. In most instances, the patient is grateful for being taken care of by a trusted and recommended professional. Unfortunately, on occasion, the patient is left with the impression that the referring dentist has “stuffed-up”. This may arise from the patient simply misinterpreting the specialist. Having an open conversation with the person to whom you have referred to can often clarify any confusion and resolve any ill-feeling. Unfortunately, there may be some good degree of certainty, the vast majority of dentists do not go to work with a plan to choose the wrong shade, place the implant into the inferior alveolar nerve canal, miss the oral cancer or lock the TMJ.

So, what is the best course of action in these circumstances? It is prudent that the specialist obtains all the necessary information about the case, including a conversation with the referring dentist if required. Of course, with the patient’s best interest front and centre, a speedy resolution is ideal. This is where ADAWA and your indemnity is especially invaluable. What is not ideal is the specialist “dogging” the treatment plan and further infuriating the patient. From a patient point of view, being angry hampers healing.

So, what does a referrer do if they hear that their specialist who they considered “the best” for this patient is apparently “dissing” them to the patient? Give the specialist a call and seek clarification on what truly occurred. Most cases, it is the result of miscommunication and misunderstanding that has spiraled out of control. A subsequent discussion between the specialist and/or dentist with the patient, almost always results in a speedy resolution. In rare cases, one might face a specialist who admits that they have criticised the dentist’s treatment plan. In these instances, the referring dentist still deserves open communication, respect, and may likely be best served using a different specialist in the future; ideally one who is more respectful.

Timor-Leste Dental Program

VOLUNTEERING SPOTLIGHT

Dr Blanche Tsetong is the program coordinator for the Timor-Leste Dental Program, the biggest dental program in Timor-Leste.

“It has a great mixture of prevention and treatment,” she says. “We are a welfare program, in that we provide free dental treatment, but we are equally a development program; we mentor and support Timorese dental clinicians and we are sponsoring a Timorese dental student in Fiji

Uni. So, we are future-focused without losing sight of the present reality.”

The Timor-Leste Dental Program maintains a base in Maubara (a rural centre 60km from Dili), which runs a general fixed clinic, as well as a school dental program, taken care of by permanent Timorese staff members.

It has enriched my life and the lives of the many people who have volunteered with us.

“Our volunteers work in our outreach clinics – we cover the greatest area of TL – and live in the villages that they work in, eat local food and work with local people,” she says. “They get to see great swathes of the countryside and experience real local culture. It’s a rewarding, if not entirely comfortable, experience. It has enriched my life and the lives of the many people who have volunteered with us.”

In non-COVID years, five dental teams are sent to Timor-Leste annually. Although trips are paused at the moment, dentists can register their interest for when trips resume, and can volunteer in other ways in the meantime.

“It is very difficult to plan at the moment,” Blanche explains. “The TLDP is looking for clinical volunteers that are keen – not just for now when they will almost certainly not be called to help – but for the next year or two.

“There is also a need for volunteers who have skills in other areas,” Blanche adds. “Clinical volunteers are important, but since our inception, it’s been the same dentists who volunteer as clinicians who have also been running the backend of this program. We are simply not that great at doing those other jobs. We need help with fundraising, with social media, with IT. Even if these are only hobbies, if they have some real skill, we would love help with all of that.”

Thinking about volunteering? WA dentist and Timor-Leste Dental Program volunteer Dr John Moran says if you are interested in volunteer dentistry, then East Timor is a wonderful place to visit. “Not only is the geography of the area stunning, the locals are so friendly and appreciative of the services we provide,” he says.