The American Heart Association (AHA)1 states that its document "Prevention of Infective Endocarditis: Guidelines From the American Heart Association" was developed through an evidence-based approach and attempts to reduce ambiguities about the patients for whom antibiotic prophylaxis may be indicated and under what conditions, as well as what antibiotics to use. Dentists should be aware that, while the precise standard of care may vary based on locale, the guidelines likely will be cited as some evidence of the standard of care in any malpractice litigation. Nonetheless, it is the American Dental Association’s recommendation that a dentist exercise independent professional judgment in applying these or any other guidelines as necessary in any clinical situation.
Should the patient present a recommendation from a treating physician with which the dentist disagrees, the dentist may wish to consult with the physician, as the goal in treatment should be to reach consensus among professionals. Communication between professionals should provide information about the bases for the physician’s recommendations and why the dentist disagrees.
If consensus on treatment cannot be reached, the answer may lie in informed consent, which usually can be relied on to protect the practitioner who respects the patient’s treatment decisions from legal liability as long as the treatment is within the standard of care. To be effective, the patient’s consent must be given after all reasonable treatment options and each option’s benefits and risks are fully disclosed. When treatment consensus among treating professionals is absent, it is prudent also to disclose that the treatment recommendations differ and to encourage the patient to discuss treatment options with the physician before making a decision regarding treatment. The dentist should note or copy all communications regarding treatment options.
It should be remembered that the dentist and not the patient ultimately is responsible for patient treatment. The dentist, therefore, is not obligated to perform a treatment he or she does not believe to be in the best interests of the patient.
The above information should not be construed as legal advice or a standard of care. A practitioner always should consult his or her own attorney for answers to specific legal questions.
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