I was very grateful for the reponses to my post rearding the dentist not listening to me regarding adrenaline in an injection. I have written my complaints and this morning NHS England, have got back to me. They identified 3 areas that they will be discussing with the dentist.
The dentist not taking into consideration my medical needs.
The attitude of the dentist concerned.
The practice removing my review on NHS Choices (this has since been reinstated)
They want to know what 3 things I want to achieve by making my complaint.
no 1 for me is that they listen and take notice when a patient gives medical information and if they don't understand ask, not presume they know better and carry on regardless.
Help on two more would be appreciated as I feel this is important to try to get them stopped from doing this again. Next time somebody might not be as lucky as I have been.
Written by
sapphy
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As a routine they should ask every patient on arrival if they have any new medical conditions which need to be taken into consideration. These MUST then be marked on patients records. My dentists always asks me if anything has changed. It is just good practise.
Well done on getting some action. One thing I remember from your post and would suggest was that they equated arrhythmias with another heart complaint, drawing on experience from the latter to assume knowledge of the former.
The problem with arrogant ignorance is that education seems to be foreign to those who display it - perhaps confirmation of a patient's condition and any restrictions caused by the condition needs to be made with a patient each time in advance of treatment. My dentist does this each time.
thank you, a good idea to feed back they definately understand why they must not ignore medical information. along with Bob's stating new information must be marked on records.
A patient should always feel at ease before any procedure. As I previously replied to you, I had a tooth extracted at time of your first post . My Surgeon cooperated without hesitation to my request of no adrenalin . There is no reason for you to not be heard. I do know the injection costs more and takes longer to numb you. Not a big deal to sit a few extra minutes to avoid an AFib attack. Good for you to follow through and not accept inferior care,keep us posted
thank you. they need to find a way to make sure dentists like this one do follow proper procedures, listen and alter treatment to fit round medical conditions. Education is a must on medical conditions and not just presuming if one organ ie the heart is affected then all conditions are similar.
Say that one of your objectives is to have everyone in the surgery equipped with up to date skills. To achieve this objective, recommend that they carry out a training needs analysis to identify any problem areas.. Feedback from patients could be one of the means of identifying those problems. Ask what their training plan is and how they track and measure outcomes.
thank you, they are also ringing me for a discussion on this so I'm writing everything down and also going to put it on the letter they sent to send back.
If they phone tomorrow morning and you are not ready just tell them that and ask that they phone you back on Monday. Don't give any details until you are fully ready because that could be misinterpreted.
Suggest that they circulate to all dentists that people who suffer or who have has AF attavk can chose whether or not to hVe the adrenalin based analgesic
My dentist knew about AF and was v happy to give me right stuff. He said he had many people who dislike the adrenalin rush. The injection made my heart rush badly when I had the adrenalin based injection before j had AF. I don't like it one bit. It might be more affective at Odin relief and speed of Jim ness but it dangerous for some.
thank you, I have asked around my friends on the dentists they use and have an appointment booked. I'm hoping this one will sort it out, he comes highly recommended.
As I said earlier you have to take control for yourself. My dentist is great but I still always ask before the injection " I presume this is without the adrenaline"
HappyJo. Very good point. Things worked out OK for Sapphy in this case but she was still put to a lot of inconvenience and heartache (excusing the connotation!!!) which was totally unnecessary. In another case the action could have had far more reaching consequences and could have caused a cardiac arrest or heart attack.
These notes are written as a friend on the forum and I don’t have any medical or legal training. It is what I would write but you must feel free to use the bits you like and exclude those that you don’t like. I have written it in the singular so that you can just cut and paste. I have widened it slightly to cover other issues that seem to prevail but where these can be linked. From the wording you have posted this will be OK. I am good at squeezing things in!!! I have also tried to make it less personal attack since in the long run that will provide more benefits. The actual text follows below.
Without Prejudice.
I strongly believe that the following must be the standard approach for all dentists since talking to friends there is a very big variation between dentists and that they are not necessarily up to date with current NICE and possibly other practices / requirements. The situation regarding many conditions, practices, medications, etc, (particularly heart and stroke related ones) have changed significantly in the last 10 years and even in the last few years. Some things are obvious and may be part of current training / re-training and what is actually done but I have included them so that things aren’t missed out and because everyone needs some retraining in their work at some time.
1) That the dentist asks all patients to confirm what health issues they have and that the dentist reads what is written in the patients computer record or manual record very clearly and asks confirmation that this is all and also checks medicines and doses. Also the dentist must specifically ask are there any other conditions? Then the dentist must ask the patient to give any further clarification(s) about any of the conditions or medication. The dentist must recognise that for conditions (such as AF) that the patient may very well know more than the dentist about the condition and, more importantly, the patient will know more about their own condition and the effects which may very well not follow the “norm” (AF seems to be a very mongrel affliction) and must not just override the patient. The dentist must, if necessary, alter the treatment to fit round medical conditions and not be afraid to say I am unsure about xxx in yours case and need to check. If the dentist is then unsure they must not proceed without taking appropriate advice / steps and not just take the risk. Note the dentist must not just say has anything changed since last visit because the patient, particularly some older people, may not fully tie-in time scales. Also the dentist must have AF, other heart conditions and other key conditions clearly written at the top of the patient’s notes so they cannot be missed.
2) That dentists recognise that there are a number of different types of heart problems and that what is appropriate and acceptable for one condition is not necessarily appropriate for another heart problem particularly where patients have co-morbidities. A patient with arrhythmias (and AF is only one type of arrhythmia) is quite different to a patient who has angina or has had a heart attack or a cardiac arrest. Someone who has AF and heart valve problems may need a different approach to someone just with AF. Anticoagulation is also key here because many heart patients are on anticoagulation (not just AF patients) and it is important not to stop the anticoagulation even for a short period because that significantly puts the patient at an increased risk of a stroke in that period of time (more so than if stopped on a longer term basis). Ask the dentist what the current NICE guidelines are regarding both Warfarin and INR level and NOACs since, from friends, I know that many do not realise the INR level and have a limited understanding of NOACs. As a default anyone with AF (whether paroxysmal or persistent) must be given adrenalin free injections. See AFA Guidelines. In the event that, during treatment, a patient’s heart starts racing or the patient starts sweating the dentist must stop and then check the patient’s heart rate (by machine suitable for AF and not finger on wrist or neck) and check the patient’s blood pressure. AF is the most common form or arrhythmia.
3) That the individual dental (or GP) practice does not have the capability of deleting or modifying any comment(s) made by the patient on a website. By all means allow the dentists to post a comment underneath and then the whole topic / subject can be raised to an area basis for resolution / discussion and in the event there is swearing or illegal language the area authority can replace words by ……. or [redacted]. Feedback must not just be a complaints issue but also random feedback from telephone calls.
Please will you let me know what the training plan is for the particular dentists involved in my incident and also Newcastle Dental Care and how they will be tracking and measuring outcomes. Also please let me know what is going to be done on a wider scale within your area.
Interesting discussion. Looking at things from outside the box, it is often a case of resistance when an expert meets someone who understands what they do and comments on it. That expert will go into a superior mode of "well, I'm the professional and know more about this than you." Happens all over. A joiner goes to a house to frame up some cupboard units and the customer starts asking him if he is going to use morticed joints rather than dowelled - and ensure the timber has a low moisture content. Same reaction...just leave it to me - I'm an expert! I think some GPs will go into a silent mode if you start quoting sensible stuff about INR figures and such. Doesn't excuse bad practice though - whether a dentist gives you the wrong injection or the joiners cupboard doors won't open properly!
Slightly off topic but to do with keeping up to date: as someone with a congenital heart condition now corrected by surgery, standing advice was always that any dental/surgical treatment should be accompanied by a course of antibiotics. NICE revised that practice several years ago in the light of known over prescription of antibiotics. The advice now is only to prescribe when needed, not as a precaution. Has anyone come across doctors/dentists still prescribing antibiotics where there is no existing infection?
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