Tales of the non-accidental tourist

MANY of us of will have sought medical attention for injuries or conditions arising while we are on holiday, but the expectation that the NHS will provide comprehensive and free healthcare dissuades most patients from seeking elective treatment out-with the UK – or at least this was true until recent years.

Lengthening waiting times and developments in European legislation, together with the advent of almost universal access to the internet and cheap air travel, have made it no longer unusual for patients to undergo certain procedures in foreign hospitals. The fact that dentists, particularly those in central Europe, have been one of the main beneficiaries of this new development does seem logical bearing in mind the shortage of NHS surgeries in certain parts of the UK and the increased costs of private treatment.

These factors, combined with the reality that dental treatment is often non-urgent and seldom impacts upon mobility, have galvanised patients to seek cheaper and more accessible treatment abroad. An estimated 20 to 35 thousand dental patients do so each year and that number is rising.

Advising patients

In recognition of this new trend, the GDC have produced a document which offers general guidance and suggests that prospective dental tourists seek more detailed advice from their UK practitioner before travelling abroad. Responding to such enquiries requires a degree of tact and insight. Dentists are ethically obliged to respect their patient’s choice and must be careful not to offer excessively pessimistic or even misleading information. However, there are valid concerns which should be raised, both to assist the patient’s decision-making process and also protect the UK dentist from recrimination should anything go wrong.

Obvious as it may seem, a useful starting point for such a discussion would be to highlight the importance of communication. Admittedly, the language skills of Europeans would put many of us in the UK to shame, with some countries even teaching dentistry in English. Nonetheless, patients must make certain that the dentist whom they plan to visit can explain the technicalities of the proposed treatment in order to secure informed consent and provide ongoing reassurance.

Cost implications

Another fundamental area that should be addressed is the tricky issue of finance. Encouraged by numerous websites, magazine and newspaper articles it’s not surprising that some patients decide that being treated abroad represents the most cost efficient means of achieving the outcome they desire. However, as no two cases are the same, patients must at least consider the possibility that the guideline charges which are often quoted in the media may escalate once an examination has been completed.

Even if an agreement is secured with regard to all dental charges, multi-stage treatment or unforeseen complications may necessitate a longer stay or return visits, incurring additional costs and possibly loss of earnings. Therefore, patients who are initially attracted by the potential discounts frequently quoted in the popular press and website testimonials must remember to factor contingencies such as these into their financial calculations.

Ensuring quality and professionalism

Trips abroad for dental care tend to be most economically viable when involving fairly extensive treatment such as implants. Admittedly, adverse outcomes in relation to treatment of this complexity are not unknown in the UK. However, such clinical complications are arguably less likely in this country because the GDC operates a stringently policed register of specialists and censures registrants who do not work within their scope of competence.

Numerous obligations restricting the administration of intravenous sedation in anxious patients also apply in the UK and general anaesthesia is simply not permitted in general practice. Such controls are not guaranteed outside the UK and the degree of regulation in some countries is variable and often difficult to research.

Websites such as Health Regulation Worldwide offer some insights into the professional bodies that oversee dentistry in other countries but it would appear that there is no umbrella organisation which offers comprehensive assistance to patients who wish to satisfy themselves that their treatment abroad will be efficient and safe. An overseas dentist may lack the experience or qualifications that would be required in the UK and this could lead to an unsuccessful or even a harmful outcome. Patients seeking compensation in another country might find that their legal position is very difficult to establish. Even if the relevant legal system is understood, pursuing a claim in negligence in another country will undoubtedly have logistical and financial implications.

Remedial work in the UK

Another common question is to what extent a UK dentist is responsible for rectifying failed work which has been carried out abroad. Faced with such a case, most practitioners will feel a degree of empathy with their patient’s plight. However, in such instances, the UK dentist is not required to bear any of the costs of remedial work. In fact, correcting unsuccessful dentistry is often more complex than carrying it out in the first place and practitioners must not, through some misplaced sense of obligation, involve themselves in work that is beyond their ability.

Instead, the presenting condition must be carefully assessed and scrupulously recorded, making use of photographs and justifiable radiographs where applicable, before a written estimate is given for work which the dentist feels will be beneficial. At this stage, it is up to the patient to decide whether to proceed on this basis or return to the dentist who provided the original treatment.

The advice thus far, while perfectly valid, does tend to reinforce the stereotypical view that standards of care and professionalism in other countries lag behind those of the UK. Yet, to endorse this position without qualification is to disregard the many excellent courses of treatments which are received by UK patients in European practices each year. It also ignores the possibility that failings in the patient’s existing dentistry might complicate treatment at an overseas practice, in which case it may be the UK dentist who ends up facing awkward questions. Therefore, dentists who are offering advice to prospective dental tourists should ensure that their own treatment to date will withstand scrutiny by a foreign colleague.

In conclusion…

Dental tourism as an inescapable facet of modern dentistry and it is an option increasingly explored by patients hoping to save money on the more complex components of their dentistry. In dealing with these patients UK dentists should explain the potential for additional costs and clinical complications which may result from having treatment abroad. However, regardless of the advice provided, they are not obligated to rectify any adverse outcomes.

Doug Hamilton is a GDP and dental adviser at MDDUS

This article will appear in Summons Spring 2012