patient cases scenario

[Dental1451]

Scenario: Patient comes in at 4:45, tooth is hurting badly and needs a RCT but all the staff have left. Office closes at 5.... do we treat them or prescribe antbx and bring them back monday?

If 15 year old patient, have to take xrays, and the 15 year old says she is pregnant but does not want to tell mom. how you going to go about in getting consent?

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[tc434]

Why are you asking, were these questions asked on a recent interview?
For the first scenario you need a diagnosis, can't just rx antibiotics.
Second scenario can probably hold off on xrays unless there is pain. Talk to the girl about communicating w her mom, pretty sure she will find out soon enough. That will be tough to hide.

 

[TanMan]

Why leave the patient in pain and production hanging? If it's your own office, go call one of your staff members to come back and just do the RCT bu crown. Do not do any procedures alone without anyone else there.

Under 18 have little/no rights unless emancipated. Check your state laws. If you really don't want to tell the parent that she's pregnant, tell the parent that that their child is not consenting to the xrays.

 

[Applebd]

For the first question: Why would you leave the patient in pain? The welfare of the the patient is more important, extend your hours, if you are the dentist and you own this clinic, give an overtime pay to your staff. Be more empathetic. The patient is more than just a PATIENT.

2nd question:
Hold off on x-rays unless it is necessary. Talk to the girl that she has to tell this to her parents as soon as possible. Her parents will know this in the long run. It has to be sooner, for the health of the baby.

 

[FDCMC]

As professionals, we should attend to our patients with outmost care. That means able to stay up and work additional hours to assist in every way we can. It unprofessional to have them come back on other days, just because we are going home.

The 15 year old is still considered a minor. Meaning she still doesn't know the huge consequences if she will still hide the truth from her parents. If she will be 3 or 4 months on the way, the more that she needs to tell this to her parents. She needs to see a OB-GYN. As for the Xray, you can do the Xray if it is really necessary.

 

[schmoob]

If you really don't want to tell the parent that she's pregnant, tell the parent that that their child is not consenting to the xrays.

I disagree with this part, respectfully.
She is a minor, so before moving forward with any sort of treatment I would ensure the guardian has informed consent - which includes an accurate medical history. Pregnancy is also a detail I would not leave out of this patient's chart. The situation between mom and daughter would need to be sorted out between them before moving forward, IMO. Bad news doesn't get better with age.
I would also ensure that another staff member be present during any and all conversations with members of this family.

 

[TanMan]

I disagree with this part, respectfully.
She is a minor, so before moving forward with any sort of treatment I would ensure the guardian has informed consent - which includes an accurate medical history. Pregnancy is also a detail I would not leave out of this patient's chart. The situation between mom and daughter would need to be sorted out between them before moving forward, IMO. Bad news doesn't get better with age.
I would also ensure that another staff member be present during any and all conversations with members of this family.

As it varies by state, it's hard to say what to do, since your State Law will dictate what you can and cannot do. The purpose to telling the parent that they do not consent to the radiographs is to encourage dialogue between parent-child without having to put you in that position. The other question to ask the minor would be, are you sure? and if they are, make them mark it on the medical history. If not, then it didn't happen.

Edit: Follow up dialogue would be: I'm going to give your daughter a referral to an MD for "evaluation" and let them sort it out. This would be in a scenario where if a state law indicates that I cannot disclose that to the parent, then this would be the work around. If there's no restrictions legally to disclosing to a parent, then the easiest solution is just to tell the parent.

 

[LordOfOMS]

It largely depends on if the child is pregnant by immaculate conception

 

[laundry]

1) Need a diagnosis first - restorable? Pt interested in saving? if irreversible pulpitis, antibiotics will accomplish jack ****....if, however, pulpal necrosis, antibiotics and pain meds might not be a bad idea... I always wonder if it's such a horrible pain, why wait until 4:45 to show up....
2) Your first mistake is not conducting a full med Hx prior to Rx'ing X-rays....but also, by law, you have to notify authorities...