Medical doctors are often accused of practicing what is known as defensive medicine. With defensive medicine, a doctor will deviate from the normal practice of medicine in order to perform a medical treatment or run a diagnostic test in order to reduce potential exposure to a malpractice lawsuit. This leads to treatments and tests that are not clinically necessary and is often said to be a cause of overtesting and overtreatment. Defensive medicine is discussed as serving to protect the physician from a lawsuit by the patient.
What is not discussed is the idea that a patient can also practice defensive medicine to protect the patient from losing a legitimate lawsuit against the physician. Applying this concept to wisdom teeth surgery, the following is suggested for a patient to help protect themselves from losing a legitimate lawsuit against a physician, dentist, oral surgeon, or dentist/doctor assistant:
1. Video tape the oral surgery and subsequent events
The concept of video taping the wisdom teeth surgery and events following the oral surgery is not new. It has been discussed on this site in the past such as in the post How to Improve Your Chances to Win a Dental Malpractice Lawsuit. It is suggested to video tape the surgery from multiple angles and using a high resolution device if possible. You also want to make sure you bring at least one family member or friend with you to the surgery to video tape you after the oral surgery is complete and for your trip back home. Having such video evidence can help prove that you didn’t fall and injure yourself or hit your head while leaving the hospital or office. Such video tape evidence also has particular usefulness in the event there is any dispute about a sexual assault occurring shortly before, during, or shortly after the oral surgery. As described in the post Recent Cases of Dentist Assistant Sexual Assault During Wisdom Teeth Removal, there was an instance where a dental assistant inappropriately touched nine women and penetrated one woman shortly after wisdom teeth surgery that was captured on security cameras that had been installed.
2. Record all conversations related to the oral surgery and subsequent events
Many times patients file lawsuits after wisdom teeth removal complaining about a lack of informed consent occurring. Discussion of the informed consent process has been made on this site before in posts such as Informed Consent in Dentistry: Can Change Impact Personal Injury Cases? In some instances, these cases can have legitimate arguments. To help strengthen such arguments, it is of course helpful to have an audio recording of any conversation that took place with the dentist, oral surgeon, and/or or dentist/oral surgeon staff. It is also useful to have such audio recordings when the oral surgeon or dental staff try to deny that a complication that occurred was related to the surgery. This is done using tactics such as by saying “(1) the problem was not related to the surgery or (2) send us follow up diagnostic testing results from a medical doctor so we can determine if your problems are related to the oral surgery as we have never heard of that problem happening.”
3. Have adequate diagnostic imaging scans performed prior to surgery
Prior to wisdom teeth surgery, you will need at a minimum a panoramic x-ray performed to evaluate your teeth. A panoramic x-ray can visualize the alveolar inferior nerve but it can not visualize all the nerves that can potentially be damaged during wisdom teeth surgery. Thus, in certain cases individuals should also have cone beam CT (CBCT) performed.
Another known complication of wisdom teeth surgery is that it can result in a mouth-sinus hole and lead to sinusitis, see http://www.teethremoval.com/complications.html. However, it has been estimated that many patients have a sinusitis appearance on imaging tests without even knowing it. In order to clearly know if the appearance of sinusitis is present or not, it suggested to have a baseline scan done prior to having any wisdom tooth extracted. Since a CT scan leads to more radiation, it has been suggested to have a brain MRI done prior to any wisdom tooth extraction.
4. Have adequate blood work, vaccinations, and evaluations by a physician completed prior to surgery
Prior to having wisdom teeth surgery performed, one should be recently evaluated by a physician, such as through what is known as a physical appointment, and know their past medical history. Current medical conditions one may have could potentially lead to more risky surgeries and this information is important to be communicated to the oral surgery team. For example if one has a known immune disorder such a hereditary angioedema, this is important to be communicated or failure to provide this information could potentially result in death.
One should also be up to date and current with any immunizations or vaccinations. This includes three doses for Hepatitis B and subsequent Hepatitis B antibody testing to ensure the vaccination provided immunity by showing Hepatitis B surface antibody greater than or equal to 10 mIU/mL.
As discussed in the post, Acquiring Hepatitis C at the Oral Surgery Office, a Hepatitis B antibody test, a Hepatitis C antibody test, and a HIV antibody test should all be completed prior to surgery. The purpose of this is to know your status prior to the surgery, so you can potentially prove, if you happened to acquire one of these infections during surgery, that you didn’t have it prior to the surgery.
5. Pay attention to the time of the day the surgery is scheduled
Most patients who schedule wisdom teeth surgery probably only think about the time it is schedules as it relates to what the office or hospital has available and how this works with their own personal schedule. But such an approach may be a mistake. For example if you are receiving medical gas during the surgery, it may not be ideal to be the very first patient in the morning after the office has been closed for a few days. An example of this would be if the office closes for the weekend you may want to avoid the first slot available on Monday morning, see the post Wisdom Teeth Removal Leads to Coma. Similarly, you also do not want to schedule at the very end of the day, as having the last patient slot for the day should be reserved for those patients with hepatitis or HIV. Furthermore, those patients with surgery late in the day may have an increased risk of acquiring an infection such as hepatitis or HIV, see the post Acquiring Hepatitis C at the Oral Surgery Office.
6. Have a back-up and emergency plan in place
Unfortunately there have been cases where the oral surgeon who performs the surgery later becomes very defensive if a complication where to occur. This could make it difficult to want to continue being treated by them or to even trust them. It is even possible that the oral surgeon who performed the surgery will not provide any continuity of care if a complication occurs. Thus, it has long been suggested (see http://teethremoval.com/complications) that one should have a backup oral surgeon or dentist to visit in case this were to occur. In addition to this, one should have a medical doctor who they can see if the need were to arise. Furthermore, one should know of the nearest hospital emergency room to their place of residence and the office where the procedure occurs if having oral surgery done in an office setting. Finally, it is important that other individuals, such as family or friends, are aware that you are having surgery so they can assist if your state deteriorates and are needed to step in to help assist you with getting medical care.
Summary
While doctors like to practice defensive medicine to try to limit lawsuits won by patients, why should only doctors get in on the action? Therefore, it is suggested that patients take the six steps outlined above in order to help reduce the chances they fail to win a legitimate lawsuit after wisdom teeth removal. It should be noted, that none of the details of six steps above are part of any standard of care for wisdom teeth surgery. Like defensive medicine, some of these could be argued as not clinically necessary and overtesting and overtreatment However, with proper planning and close attention to details, in the event something were to negatively happen with wisdom teeth surgery, following these steps could lead to potential better medical and legal outcomes for patients.
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