Needle phobia - dental case study

...the patient said that "before she knew what was happening" the dentist was injecting her with a local anaesthetic...

BACKGROUND: A dentist with a large urban practice – Mr T – receives a letter from the GDC regarding a patient complaint that has been referred to the council’s Investigating Committee. Enclosed is an assessment sheet detailing allegations from a Mrs Y who had attended the dental surgery six months previous. These involved a failure to obtain informed consent before administering a local anaesthetic.

In her statement the patient claimed she made an emergency appointment with Mr T to treat a broken tooth. The dentist took X-rays and asked Mrs Y to make an appointment in order to have the tooth restored. Four days later the patient arrived for her appointment late and flustered having not been able to find a parking space.

Mrs Y sat in the chair and opened her mouth as requested and “before she knew what was happening the dentist was injecting her with a local anaesthetic”. She waved her hands to indicate for the dentist to stop. The needle was withdrawn and Mrs Y was left “shocked and shaken”.

Mr T asked the patient if she wanted to continue and although Mrs Y wanted to “rush out of the room”, she composed herself and let the dentist proceed with the restoration without anaesthetic. Later Mrs Y became so upset the practice manager had to take her into the staff room. Mr T spoke to her and it was then alleged that the dentist told her that he did not routinely ask patients if they wanted an injection as it “only made people upset”.

Mrs Y left the surgery shocked and angry at having to pay £50 for such a “frightening ordeal”.

ANALYSIS AND OUTCOME: Mr T contacted MDDUS immediately on receipt of the GDC letter and forwarded it along with a copy of the patient notes and his own account of what happened.

In his statement Mr T claimed he explained to Mrs Y that before starting treatment he would numb the tooth. Mrs Y offered no reply and there was no indication in the notes that she was fearful of local anaesthetic. First he applied a topical agent to numb the mucosa and after two minutes inserted the needle. Mrs Y raised her hand and the needle was immediately withdrawn. Later in the staff room she accused the dentist of using “sleight of hand” in inserting the needle which Mr T firmly denied along with the allegation that he rarely asked patients if they wanted anaesthetic.

MDDUS assisted Mr T in drafting a letter to the Investigating Committee and a few months later the GDC replied stating they were satisfied with the dentist’s account and would not be proceeding any further with the matter.

KEY POINTS

  • Explain to patients what you are going to do even in the most routine procedures.
  • Ensure patients have listened and understood.
  • Do not presume an open mouth is consent to treatment.
  • Work out in advance a “stop” signal with phobic patients.