Wednesday 10 November 2010

Dentists Have No Right To Demand Personal Information, After All

Following my recent piece about dentist enrolment forms - and prompted specifically by the fact that commenters told of being denied treatment for wishing to keep personal details, err, personal - I was intrigued as to policy in this area of NHS care, so made a few enquiries.

The reply to my FOI request on the matter popped up in my inbox yesterday, the relevant highlights being (emphasis mine):

[What is the] official Department of Health guidance to dentists on the procedure for dealing with patients who refuse, or are unwilling to divulge, details of their tobacco consumption and/or weekly alcohol unitary intake?

The Department has not issued any guidance. As stated above, it is not a mandatory requirement but good practice for dentists to collect information on patients’ tobacco consumption and alcohol intake. The dentist will take no further action where the patient declines.
By 'no further action', one assumes that dentists are supposed to respect the patient's decision and carry on regardless.

Which wasn't the experience of Snakey in the comments last month.

I restated that I did not wish to fill the form in. After I had sat down one of the receptionists went off to tell my dentist about my lack of form filling obedience, like the good little drone she was. When she came back she imperiously demanded that I step towards the reception desk. She then told me that my dentist would not treat me unless I filled the form in. I walked out.

I now have no dentist as I still refuse to fill in the form. I don't actually drink but that's beside the point. They have no right to refuse me treatment just because I won't go along with their little game.
Indeed, so why are dentists under the impression that such info is to be treated as mandatory despite the DH saying that it isn't?

The FOI reply pointed to this document [pdf], issued to all dentists last year, which contains chapters on 'Stop smoking guidance' (p.38) and 'Alcohol misuse support' (p.40-41). In the case of smoking, the advice to dentists is:

• All patients should have their smoking status (current, ex-, never smoked) established and checked at regular intervals. This information should be recorded in the patient’s clinical notes.
• All smokers and those chewing tobacco should be advised of the value of stopping and the risks to their health of continuing. The advice should be clear, firm and personalised. It is essential that the message to all smokers is complete cessation
• All smokers should be advised on the value of attending their local NHS Stop Smoking Services for specialised help in stopping. Smokers who are interested and motivated to stop should be referred to these services.
Interestingly, however, there is no mention at all of cataloguing the alcohol intake of dental patients, just the usual rehashing of recommended units which, as we know, are about as scientific as 'think-of-a-number-and-halve-it'.

'Tis true, then. There is nothing in DH guidance that demands dentists take such info before affording treatment. Especially in the case of alcohol where they aren't even advised to record it in the first place.

And nowhere is it even hinted that treatment should be denied entirely.

The British Dental Health Foundation, however, replied to my query on the subject with an attempted explanation as to why dentists do so, albeit one which doesn't hold much water.

If the dentist is unable to access the information he may feel necessary to maintain your oral health and dental care he could decide that he would therefore be unable to treat you.
A trifle melodramatic, doncha think? Considering that the BDHF point out that the data is used by dentists to "look out for any signs for early detection" of oral cancer, one presumes they could check for those signs equally well, with or without knowing the patient's drinking and smoking habits, simply by assuming the worst. Especially since, as VGIF highlighted, oral cancer is a rare occurrence anyway.

A bigger clue presented itself in a reply from a representative of the Dental Professionals Association (the 'sniffy' one), though. Targets.

Dentists have had a number of performance indicators added to their contracts, including smoking cessation targets. We know that manipulation of the contract in this way does give rise to odd side-effects however we have not come across the problem you describe.
Which makes me rather more of an expert on patients being denied treatment than a body employed in the industry itself. Three commenters here pointed to either being refused or being effectively bullied (my experience), yet the DPA have never heard of such a thing. How odd.

In summation, while it is clear that NHS dentists are refusing treatment for patient non-declaration of smoking status and alcohol unitary intake, they aren't mandated to do so under current DH guidelines.

I'll leave the last word on this to Sam Duncan who articulated my thoughts perfectly in the comments to an article here last week.

Sure, if I come along to you proposing a commercial transaction and you don't like the colour of my money you can tell me to sod off for no other reason. It's a fundamental principle of the free market - of freedom - and, as we know, one that's under threat from so-called “rights” that are nothing of the sort.

But if you lay claim to my money, taken from me under threat of force on the pretext that you're providing a vital public service, then the tables are turned, matey. You have a duty to do the job, because I (apparently) have a right to it, and tough luck if I'm a bit uppity and won't answer your irrelevant questions.

Something to bear in mind next time an NHS dentist - who you are paying via taxation - threatens a refusal to perform his part of the contract simply because you'd prefer to keep your lifestyle choices private.


selsey.steve said...

I attend, as an NHS patient, a dental clinic in a town close-by on the South Coast. I am always treated by a pleasant young lady who hails from Middle Europe and who is possessed of a name I can neither pronounce nor spell.
On my last visit I was asked questions such as what medication, if any, I am taking regularly. This I could understand. At one point the lady said "You are a none-smoker" in an affirmative tone. Thinking that she might be intoning incorrectly I said that I was, in fact, a smoker.
Her reaction amused me. She reiterated, quite strongly that I was a non-smoker, and took out a packet of cigarettes from her uniform pocket. "Like me, you are a non-smoker" she said, shaking the packet at me.
The penny dropped. "I am a non-smoker" quoth I. This was duly entered into my records as we smiled at each other.

banned said...

Quite so selsey.steve, just lie to them, what can they do? Prosecute you for perjury?

Longrider said...

Interesting. Now that I am back in the UK, I'll be having to register with a dentist. Let battle commence...

Ciaran said...

This is all very strange.

For the first time ever, about three years ago, I got an NHS dentist instead of a private one. In that time he's never so much as mentioned alcohol, tobacco or any other irrelevancies of lifestyle. He talks about teeth, he looks at teeth.

He's also very good, and speaks English well enough that you can actually understand what he's saying. I doubt he'll be working for the NHS for long, sadly.

Anonymous said...

If they can't tell by looking in your mouth whether or not you drink or smoke, it can't be having that much effect.

Snakey said...

I am not at all surprised by your research DP. Most organisations like to make out that their "rules" are real, when they aren't - it's just being power mad. I know I could have simply filled in the form and made up any old guff about my smoking and drinking habits but I suppose that day I'd just about had enough of officious dental receptionists telling me what to do. It's not like I get free treatment, I've always paid for it. Of course, when I said I wouldn't fill in the form an older receptionist barked at me that if I didn't they wouldn't get paid via the NHS etc (like I give a stuff). It never even occurred to them that I might a) have a problem filling in forms, b) that I was just out of sorts that day or c) that I didn't want to fill in ALL the sections.

If I ever do need a dentist I will go private. This is a shame because until my dental practice was taken over by Oasis (i.e a corporation) I had a lovely, relaxed, gentleman dentist who left immediately, to be replaced by a Greek bloke who I could never understand.