When I published this video/write-up on the patient who had neglected to inform me he had been on Suboxone, I received a lot of backlash from people who thought I was a 'heartless, judgmental, inconsiderate dentist' because I told the pharmacist not to fill the patient’s prescription for hydrocodone. Here is one of the responses I sent:
You completely missed the talking point of the article. My issue wasn't the fact that he was on Suboxone; it was that he DIDN'T disclose it. Any prudent medical provider reading that write-up would understand my point and, subsequently, concur. Your reference to my oath is irrelevant; when a patient signs a LEGAL medical form saying it's filled out honestly and correctly when it's actually NOT, that's on the patient—not me. Serious ramifications for nondisclosure are not something to take lightly, and any physician, regardless of discipline, will acknowledge that fact. Your argument, thus, has zero ground to stand on. Your assumption of me being naive is emotionally based, and your acerbic tone and judgment hold no sway in my decisions as a medical provider.
I’m standing my ground on this one.
Fast-forward to today when a patient who had come in for a root canal opted to keep the tooth in lieu of extracting it. When I asked if her medical history had changed, she said she started taking a “baby aspirin” because she had a bleeding disorder and “her doctor was worried.”
I looked back on her medical history and a bleeding disorder was not listed. Further inquiry revealed that the patient had thrombocytosis, a condition where the body overproduces platelets, putting the individual at a high risk for heart attack, stroke, or generalized/abnormal clotting in the blood vessels.
While this condition isn’t something that would likely be an issue for an extraction (thank goodness), there are potential ramifications from not having a full, complete, and honest medical history.
What if the patient had von Willebrand disease? Early on in my dental career, I had a patient who failed to disclose that tidbit, and my “simple extraction” turned into a rushed visit to the oral surgeon. Was that my fault or the patient’s?
Case in point: EVERYTHING on a patient’s health/medical history is important and relevant.
One reader suggested that we stress the importance of a complete medical history on our patient forms for their safety and state that “omissions in your medical history including medications could result in dismissal from this practice.” Not a bad idea since the patients are always right!
And to my critics—I will submit and even vehemently argue the point that when YOU receive care from your medical providers—regardless of the reason—you want them to be on their game, because no one deserves below-par care. But in order for that to happen, honesty, integrity, and understanding must be reciprocal by the patient and provider alike.
Cheers, my friends! Keeping it real, raw, and unafraid...
Dr. Stacey
Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.
