Duty of care

Sir, I read with interest your recent editorial (BDJ 2010; 209: 421) regarding ethics in today's dentistry. It was followed by a letter from A. Sorrell (BDJ 2010; 209: 423) raising a number of points on corporate bodies and their apparent failings to provide a duty of care to some patients. There has been frequent discussion concerning dentists who may be under pressure regarding UDAs having to pick and choose the treatments received by patients in high need. One must remember our duty of care is to our patients, not our employers.

In addition to the points raised by A. Sorrell, I would like to draw attention to the misuse of the referral system which I have observed whilst working in the hospital environment. It sees high numbers of routine restorative treatments which may not be financially beneficial to the dentist finding their way on to hospital waiting lists. Whilst teaching hospitals are thankful for some routine treatments for undergraduate students to put into practice skills learnt on phantom heads, patients can spend months waiting for treatment, often in pain and end up needing treatment which is more extensive than when the referral was originally made.

Many referrals extended to oral surgery where patients were referred for routine extractions due to 'dental anxiety'. This anxiety was often not known to the patients concerned who were more than happy to have extractions under local anaesthesia. I am unsure whether the reason for these referrals is due to the UDA structure or the recognised lack of oral surgery experience as an undergraduate for recent graduates.

In a manner as to not discourage referrals, repeat referrals for routine treatment from the same dentists/practice may warrant further investigation. These dentists may appreciate support from postgraduate centres. Appropriate practical courses may improve the dentists' confidence in providing certain treatments for their patients.

Whilst the option remains for hospitals to write back to dentists enquiring as to why certain treatment cannot be carried out by the referring dentist, this places the patient at a further disadvantage of waiting even longer for treatment. Hence patients getting treated using hospital resources. One would hope the ongoing review and future proposals for the UDA system may improve this situation.

Finally, I would like to acknowledge that not all questionable referrals I have experienced were from corporate bodies, but a significant majority were from that source.