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Next step if a patient refuses SRP?

Recently my boss came to me and ask for my opinion on what our protocol should be if a patient declines SRP but wants to continue with restorative treatment ? The refusal form is one step we take but is that enough? I believe in Thorough documentation and bringing up the state of disease and risk and benefits of SRP tx at each recall. But just curious on anyone else’s experience on this and or any tips to go about this in a legal form ? Thank you 🙂



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Author Note:
Meant too add-- when should a patient sign a SRP refusal as well ?

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2 Answers

Most dentists I’ve worked for, won’t perform restorative treatment until a patient’s periodontal disease is under control. The exception is if the patient needs palliative care for rampant caries. This is really up to the dentist’s discretion though.
 
According to the ADA, the office is not legally covered with signed refusal forms: “If the patient refuses the proposed treatment, the dentist must inform the patient about the consequences of not accepting the treatment and get a signed informed refusal. However, obtaining an informed refusal does not release the dentist from the responsibility of providing a standard of care. If, for example, the patient refuses to have radiographs taken, the dentist should refer the patient to another dentist when the original dentist believes that radiographs are a necessary prerequisite to proper care in that case.” This is stated on page 16 of http://laneykay.com/dentalpractice_dental_records.pdf. What this is basically saying is that refusal forms are something to be used, until it gets to a point of not providing the standard of care. For example, a high caries risk patient refusing radiographs should be signing a refusal form each time they refuse, but once it hits two years, it may be time to refer the patient to a different dentist, according to the ADA.
 
As far as a patient refusing SRPs, I’ve read articles that suggest doing the less ideal treatment and do a debridement. I’m not exactly on-board with this recommendation because the debridement code definition clearly states that it is to be used for patients that have so much debris, a doctor cannot do a proper exam, so I feel this is a misuse of this code. Misuse of codes can lead to insurance fraud. I worked for a doctor once that after so many times of a patient refusing perio treatment (or radiographs), he would refer the patient to a different doctor/dismiss the patient because he simply couldn’t take on the liability to the office or risk his license. This is a tough one because as a clinician it puts you between a rock and a hard place. It feels wrong to not provide needed treatment, but it also seems wrong to dismiss a patient because they can’t afford treatment. There’s just no good answer here, unfortunately.
 
While patients do have the right to refuse treatment, practices have an ethical responsibility to abide by the standard of care. We live in a sue-happy society and we don’t want our licenses jeopardized.

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Thank you so much for the information !

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