Much has been said about the role of doctor/patient communications as it relates to medical malpractice suits. It generally is agreed that the breakdown of this communication often can lead to an increase in nonmeritorious suits and the prolongation of meritorious suits.
Positive communication in practice transitions is no less important. It does, however, become more complex because we are dealing not only with doctor/patient communication but also doctor/doctor communication. There also are economic factors that come into play that can affect both of these.
It is important to look at these factors separately as they pertain to practice transition to protect patients’ rights and to communicate treatment necessities in a noninflammatory or prejudicial manner.
The first step in transition often is finalizing the buy/sell contract. Just as dentists have an ethical obligation to their patients, so do they have an ethical responsibility to their colleagues. This includes not only patient treatment but also business practices. Following this philosophy, one would conclude that in a practice transition or sale between two dentists, it should be based on fair market value with neither trying to get an unfair advantage economically. Gaining an unfair advantage will lead only to future discontent and the establishment of a negative relationship between the initial dentist and his or her successor. This, in turn, causes negative communication that, when carried over to patient treatment, can result in an increase in nonmeritorious lawsuits.
In an ideal situation, once a fair value has been established and accepted, there should be mechanisms established to address the need for dental work that should be redone. Often this can be accomplished by the selling dentist’s remaining in the practice for one year or more, which will give him or her the opportunity to re-treat if necessary.
Other arrangements may include allowing the selling dentist to return to the practice to provide re-treatment or the holding of money in escrow to provide for re-treatment costs. These all are difficult to accomplish, however, if there has been a breakdown in communication between the buying and selling dentists.
The buying dentist also has an obligation to set a treatment baseline for all patients in the practice. Doing so would include taking a medical history, taking radiographs, performing clinical examinations (including periodontal and cancer screening) and using study models, if necessary. Once this baseline has been established, the subsequent treating dentist has an ethical obligation to present a detailed treatment plan to every patient. This would include a description of any oral pathology or disease and the treatment modalities necessary to correct it and bring the patient to a state of good oral health. This process should be accomplished professionally and without an inflammatory slant.
Too often, we see a subsequent treating dentist being overly critical or prejudicial in his or her assessment and presentation. This is especially true when a pre-existing negative relationship and lack of communication exists between the two dentists. One of the areas in which we see this most frequently is in practice transitions.
As stated earlier, the selling dentist ideally would have an opportunity to correct any clinical deficiencies in his or her treatment. If this is not possible, the subsequent treating dentist must make the patient aware of those deficiencies and correct them in a timely fashion. The subsequent dentist should remember, however, that a number of factors can affect the outcome and longevity of clinical treatment. These include, but are not limited to, patient cooperation, special medical problems or conditions, and home care.
The selling dentist ideally would have an opportunity to correct any clinical deficiencies in his or her treatment.
When questioned by a patient as to why work is being redone, the dentist should include these factors in any discussion. Presenting a fair and balanced assessment of the need for retreatment will not lead to an increase in nonmeritorious professional liability claims.
The subsequent treating dentist also should be aware of the accepted standard of care for various treatments. There often is a clinical range of acceptability, and something less than ideal still may be acceptable. Standards or parameters of care are established by the American Dental Association or specialty organizations and are available from them.
Thus, the establishment of a fair practice transition mechanism, the maintenance of positive communications and the presentation of a fair, accurate, ethical and nonprejudicial treatment plan all are key elements to a successful practice.
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