Moral appointment dilema

tirednewdad

Hello, for those of you who don't know me i'm tirednewdad, one of the dentists who visit this site, and i have a moral dilema.

I am mainly private but we do have some patients who are still NHS.
One of the NHS patients continues to fail to attend appointments, wasting time for everyone.
She has missed a total of 6 appointments totalling 3 and a half hours of NHS appointments this year alone. Now normally i would say to deregister her as she has been warned before, however there is an issue with her mental health.

She has a history of Depression with suicidal tendencies, as well as issues with moods and anxiety. Her family, who also visit the surgery, have spoken to me that she is so worried about loosing her teeth that she has threatened suicide unless she gets her dental treatment.

She was given the benefit of the doubt and another appointment was made. Again she failed to attend. We phone her before each appointment on the day but she still fails to attend. We have even taken the steps to contact her family for her appointments (with patient permission) but the result is the same.

We have discussed it within the practice and the overall feeling is to consider deregistration, but noone wants to make the call in view of the consequences it could trigger.

What would you do
1) deregister her but also inform her family for the support she will need. Also give her details of a near by NHS practice.

2) Continue to provide her with appointments, which cloggs up the NHS appointments and just accept the loss of earnings and potentailly lose the ability to treat people as NHS patients if we do not hit our targets.

It is noted that you cannot charge for missed appointments on the NHS contract and she cannot afford to pay privately for her treatment

I consider myself caring but don't know what to do?:p

silvercar

Is she making it to some appointments and missing others, or has she not actually made it into the surgery?

tirednewdad

she makes some but probably misses 2 out of 3

mouseymousey99

Hello - I saw my own NHS dentist yesterday who saw me at short notice as I had something which had started to worry me, the chap was brilliant & I thanked him and the nurse for doing so.
Ok well if you've met me on the board you would see I do stand up for benefit claimers, I am one, and I'm sick to death of hearing about benefit abuse.
I would write stating you can no longer treat, as missed appointments etc. As said the NHS will provide lists of nearby dentists. Personally I would not contact family members, unless you are also friendly out of hours, as it seems to breech confidentiality?
However, I do think this person is not being fair to you or your staff either. You are not a doctor, nor can you rely on things said third hand. I have had depression, its awful, bloody awful but its something only the person who has it can deal with (if you see what I mean)?
It also occurs to me while this person is not attending her own appointments lots of other people would ? Best wishes...

silvercar

There are inconsistencies, if she is suicidal at the thought of losing her teeth, why is she missing appointments? Have her family told you this, in order that you feel obliged to still see her?

Presumeably she has the support of community nurses etc. If she needed a new NHS dentist, they would sort it out for her. I had a friend who was sectioned and living temporarily in a hospital MHU. She needed a dentist and was taken by the staff to one.

If you can't see her any more, someone else will. It is not your obligation to save the world. You've done what she can, let someone else take the reins.

Janey51

Couldn't you contact your local PCT and get advice from them?

bandraoi

I would double book her appointments.

mouseymousey99

Sods law then the person would turn up, and you dissapoint someone else??

tirednewdad

If you can't see her any more, someone else will. It is not your obligation to save the world. You've done what she can, let someone else take the reins



This is the kind of quote that i needed to hear, to reassure me. Thankyou.

Thankyou to everyone else- a quick response to everyone
1) i have the patients consent in informing family and have checked with my lawyers that it is still applicable in teh case of deregistering her.

2) yes her missed appointmetns are double standards, but she also attends the surgery with cut wrists and i saw a rope burn around her neck.

3) Double booking will work for the appointments, that she doesn't turn up for but not for the ones in which she does. It would be unfair to the other NHS who i would then be late for and probably spending less time with them, in order to catch up again

I am still interested in peoples opinions though. Please feel free to add.

sandra_nz

What a difficult situation you find yourself in, I understand your dilemma.

Given that you are able to communicate with the family over this issue, would it be possible to ask for a family member to take responsibility for getting her to the appointment?

Nicki

Is there a community dental health team in your area (ie one which specialises in treating adults and children with mental health difficulties and learning difficulties)? If so, I would de-register her and refer her to this team.

If not, and assuming she currently needs treatment which is ongoing, I would perhaps make one last appointment for her, for the last appointment of the day, and tell her that if she misses that appointment she will be deregistered. I would ask her to phone the surgery at lunchtime of that day to confirm that she is coming, and if she doesn't make that call, I would feel free to offer the appointment to anyone needing to be seen as an emergency.

At the end of the day, whatever her mental health problems, you are not helping her. In fact by continuing to excuse her behaviour, you are encouraging a learned helplessness about her situation. Having suffered badly from depression myself in the past, from personal experience I can tell you that the only way to recover is for the patient to start taking responsibility for themselves and to force themselves to do things which may seem difficult.

I understand you are worried about self-harm or suicide, but it seems to me to be very unlikely that all of this woman's problems are attributable to her dental phobia, and therefore any one action by you should not be the sole cause of her self-injurious behaviour.