Such dilemmas often start at the front door with medical receptionists put in the difficult position of dealing with a patient requesting an appointment for an oral problem or symptoms, such as a dental abscess. The easy response is to say “our doctors don’t see patients with dental problems" and then to direct the patient to their regular dentist. However, a dental abscess can potentially lead to a systemic infection and hospital admission. It is important to ensure such appointment requests are properly considered and safety-netted.
Reception staff should not routinely turn patients away because they have a dental problem – particularly if the patient has been unable to get a dental appointment and are in need pain relief, emergency treatment or advice. There is always the possibility of an associated medical problem and a doctor should undertake reasonable enquiries to ascertain the nature of the patient’s condition. Once it is clear that the issue is dental and not something that a doctor can assist with, advice can then be given on how to access local emergency dental services.
In coming to a decision on how to handle such cases it is essential to remember that:
- Dental treatment as such is not covered as part of the GP contract.
- All patients should be able to access emergency dental appointments locally, and referring the patient to these is likely to be appropriate.
- Patients cannot always be relied on to provide an accurate history of their dental treatment and this, along with a lack of knowledge or expertise, may mean that a doctor is not able to offer a diagnosis or understand fully the complications which could arise from treatment. This could lead to a doctor straying outside their area of competence.
- GMC prescribing guidance states that in providing clinical care: "you must prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs".
- Should a doctor decide that it is reasonable in the circumstances to offer treatment in a dental case – perhaps with analgesia or antibiotics – they are responsible for the outcome of that decision and any follow-up required.
- GMC prescribing guidance further states that: "if a patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion”.
- In all circumstances the patient must be informed that dental advice should be sought as soon as possible and this advice should be clearly documented within the patient’s medical record.
- Failing to assess a request for treatment/appointment in what may appear to be a dental matter but proves to be symptomatic of a medical condition.
- Agreeing to treat or prescribe for a dental condition that falls outside a doctor’s area of competence.
- Failure to offer appropriate advice, including safety-netting, on where a patient can obtain emergency dental assistance in cases where you are unable to offer treatment.
- Always act within your area of competence and refer patients to the appropriate local dental services.
- Ensure that the patient is not suffering from a medical condition which requires assessment and treatment.