2 Dentists Sued for $2 million Over Missed Lesions...

jay47

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Makes me want to refer any suspicious spot on the tongue.

Had he (Arlene) documented what he told the patient and ask him to consult a specialist if the sore/numbness would go on for a few weeks, I think he could have gotten throught this.

Edit : Gender :/
 

GoGatorsDMD

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If you didn't document it, it didn't happen. During my intern year I would see stuff like that all the time and I ALWAYS tell people they need follow up, whether it's a sharp tooth making a crater in the cheek or tongue, or a radiopacity in the mandible. A limited oral exam should still include a survey for mucosal lesions and a cervical LN check. What does that take, 20-30 seconds?

The dentist in this case did not meet the standard of care by arranging follow up for something that had a fair likelihood of being cancer. She even had the patient tell her there was something going on with his tongue in the medical hx.
 

tinman831

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"once you find a lesion, you own the lesion." Live by these words. If you even suspect the presence of something suspicious, either biopsy or refer to an oral surgeon. It is your duty to follow up with the patient AND the oral surgeons office you are referring to, in order to make sure the patient goes to the referral appointment. Document everything, and if the patient still refuses to get the appropriate evaluations done, then you've at least covered your own arse.
 

teeth63a

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The only things I would have done and do differently from Dr Arlene 1) document that pt has been told to follow up with an exam 2) Tell the patient that if the lesion doesn't go away in a week, to come back for a follow up and document that as well ("pt to return if lesion still present after 1 week"). My SOAP note would probably have looked like this:

S: Pain on the side of the tongue, also a broken tooth on the same side.
O: #18 has a DL frac with a rough edge.
1 cm x 5mm lesion on L lat tongue
PAX shows no pathology #18
Pt has hx of biopsy of L tongue with neg result.
A: 1) Soft tissue trauma of L lat tongue from rough edge #18
2) diff dx - possible neoplasm
P: Advised pt options 1) restore #18 w/ DOL, 2) occ adj. Pt elected occ adj. Smoothed edge. Told pt to return if lesion does not heal in one week for referral to surgeon.
NV: exam

Honestly yes, I would have assumed soft tissue trauma as well. But I ALWAYS include "pt to follow up if (lesion doesnt go away/pain persists) in # days"

The article is ridiculous in stating that "She should not have allowed his business as an excuse for avoiding that next appointment". This is an insurance adjuster speaking, not a clinician. Patient autonomy is one of the tenets of the ADA code. Mr. Entrepreneur is a big boy...if given the proper precautions, and he blows it off, it's all on him.

Unfortunately Arlene's verbal recommendation to come back, and the lack of documentation of that is what weakens her case.
 

jay47

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The only things I would have done and do differently from Dr Arlene 1) document that pt has been told to follow up with an exam 2) Tell the patient that if the lesion doesn't go away in a week, to come back for a follow up and document that as well ("pt to return if lesion still present after 1 week"). My SOAP note would probably have looked like this:

S: Pain on the side of the tongue, also a broken tooth on the same side.
O: #18 has a DL frac with a rough edge.
1 cm x 5mm lesion on L lat tongue
PAX shows no pathology #18
Pt has hx of biopsy of L tongue with neg result.
A: 1) Soft tissue trauma of L lat tongue from rough edge #18
2) diff dx - possible neoplasm
P: Advised pt options 1) restore #18 w/ DOL, 2) occ adj. Pt elected occ adj. Smoothed edge. Told pt to return if lesion does not heal in one week for referral to surgeon.
NV: exam

Honestly yes, I would have assumed soft tissue trauma as well. But I ALWAYS include "pt to follow up if (lesion doesnt go away/pain persists) in # days"

The article is ridiculous in stating that "She should not have allowed his business as an excuse for avoiding that next appointment". This is an insurance adjuster speaking, not a clinician. Patient autonomy is one of the tenets of the ADA code. Mr. Entrepreneur is a big boy...if given the proper precautions, and he blows it off, it's all on him.

Unfortunately Arlene's verbal recommendation to come back, and the lack of documentation of that is what weakens her case.
Very interesting, had not even thought of this. I suppose they are just trying to protect us from everything. Either that, or they are taking a very liberal view of the facts. I guess you should just document that you told them to get a follow up instead of just verbally saying it.