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patient refusal to see periodontist

I have been working in an office for a few years. Once in a great while you get a patient who refuses periodontal treatment. For example. I had a patient who came in and does not come in regularly to their appts(comes every few yrs) and has 8-9mm scattered pockets and heavy radiographic calculus t/o. The pt was recommended s/rp in the past multiple times by previous hygienists and has always declined. On top of this the patient has multiple abscess that were diagnosed by us on a full mouth and we referred the pt to endo andn they never went. This patient always declines treatment. The patient was in recently and we referred the patient to the periodontist, explaining that the pockets are too deep for us to do s/rp and that a regular prophy is not sufficient for his condition. We showed the patient the radiographic calc and perio charting and spent a lot of time educating the patient on why they need to see the periodontist. The patient continues to refuse to see the periodontist and states that they want a “regular cleaning only” even though we explained that a regular prophylaxis will not get the radiographic calc or get to the base of the deep pockets. The patient does not come in regularly and i just do not know what to do since i feel like a when i do a regular prophy on a pt like this that it is neglect and is not doing anything for the pt. What have others done in this situation?

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1 Answer

As a grown adult, a patient does have the right to decline treatment or referrals. However, you also have the right to refuse to treat them. There becomes a point when it’s a liability for you and the doctor because as the trained professional you know better than to keep continuing down that path. If you do keep doing “a regular cleaning” it becomes supervised neglect. In my office a patient like this would be dismissed. It doesn’t sound nice, but again they are a liability and you must look out for you license!

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