Over-diagnosis allegation

BACKGROUND

Mr G attends a new practice to ask about cosmetic orthodontic work. He is seen by dentist Dr H who carries out a basic periodontal examination (BPE) and notes pocketing in the posterior sextants and bleeding on probing in numerous areas. The dentist tells Mr G he has gum disease which must be addressed before any cosmetic work can be carried out. Dr H recommends a course of periodontal therapy, which could be carried out by either her practice team or by the patient’s usual GDP.

Two weeks later, the practice receives a complaint from Mr G. He accuses Dr H of “over-diagnosing” gum disease for what he believes is financial gain. Mr G states that a BPE carried out by his usual GDP found no evidence of gum disease and recommended only that the patient take more care when brushing and flossing. Mr G writes that Dr H had been “heavy handed” in her probing of his gums and that her overall approach was unprofessional.

In her complaint response, Dr H stands by her diagnosis of gum disease while accepting that dentists can often have a difference of clinical opinion. She refunds the cost of Mr G’s consultation as a gesture of goodwill.

The following month, Dr H receives a letter from the General Dental Council informing her that a concern has been raised about her fitness to practise by Mr G, that will be looked at by the regulator’s case examiners. Specifically, it’s alleged that the treatment Dr H recommended was not clinically indicated and she failed to obtain informed consent.

ANALYSIS/OUTCOME

Dr H contacts an MDDUS dental adviser (DLA) for advice.

The DLA notes a report from a GDC clinical adviser who, based only on recent radiographs, opines that Mr G has good oral health with only mild gingivitis. The GDC clinical adviser is of the view the patient was not given accurate advice and could therefore not make an informed decision about his oral health needs. The clinical adviser concludes that the treatment proposed by Dr H fell below the standards expected of a dentist of her experience and training.

The DLA prepares a response to the GDC, in consultation with Dr H, denying the allegations. The letter offers a vigorous defence of Dr H’s original findings as being an accurate representation of the clinical picture at the time of examination. The adviser highlights the fact that the GDC clinical adviser’s views were based only on radiographs rather than on an independent clinical examination of the patient – making it impossible for them to reach a conclusive opinion on the presence or absence of periodontal disease.

The GDC case examiners consider all the evidence and decide the allegations should not to be considered by a practice committee. They close the case and issue Dr H with formal advice. In particular, they advise that she should ensure she is up to date with current good practice in in assessment processes for periodontal disease, and that she is mindful to ensure patients fully understand any diagnosis given.