CLINICAL DECISION MAKING, TREATMENT PLANNING AND CASE CONSULTATION V

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CLINICAL DECISION MAKING, TREATMENT PLANNING
ANDCASE CONSULTATION V

• THE CASE CONSULTATION

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Consultation Appointment

• Prior to the Consultation Appointment, the
  dentist will have prepared a plan of therapy for
  the patient that represents her/his best
  judgement and recommendations as to the course of
  therapy to pursue to gain a level of oral health
  for the child commensurate with her/his
  understanding of the goals of the parent.
• This plan will be open to revision based on the
  consultation with the parent and any concerns or
  constraints they might raise of which the dentist
  was previously unaware.

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Purpose of the Consultation

• To deliberate with the parent regarding the
  problem(s) identified, the goal(s) possible, the
  alternatives available, and the results
  anticipated (prognosis).
• To advise the parent of the anticipated financial
  investment required to achieved mutually agreed
  upon goals.
• To gain an informed consent to care.
• To inform before you perform (A well-known
  proverb among sages of practice administration.)
• To educate the parent regarding the issues of
  oral health.the doctor as teacher.
  _____________________
• Reference discussion of Deliberative Model in
  CDS 828

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THE PHYSICAL ENVIRONMENT

• Ideally, the consultation (or case presentation)
  with the parent should be in a designated
  consultation/education area.
• Contemporary, progressive dental practices, which
  place treatment planning and case presentation at
  the core of the administration of their
  practices, will create an area for education and
  consultation.
• Such an area will include a comfortable setting
  for discussing the case as well as audio-visual
  aids (photographs and videos), brochures, and
  models for education.
• Many practitioners use their own offices as an
  area for consultation and there are advantages
  of doing so, such as personalizing the setting,
  and thus the experience.

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PARTICIPANTS

• Obviously, one parent should be present. Most
  frequently this is the mother, though this is
  changing somewhat, with fathers or both parents
  being a case of increasing frequency.
• The child should not be present, as s/he can
  disrupt the consultation by demanding the
  parent(s) attention. Additionally, the
  conversation may prove fear-promoting. The dental
  hygienist or assistant can take the child to the
  operatory to begin a discussion/demonstration of
  oral physiotherapy.
• Some practitioners use a dental hygienists to
  accomplish the consultation, joining the
  conversation at its end to answer specific
  questions.

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Format for Consultation

• Introduction
• Findings
• Problems/Goals
• Treatment Recommended
• Appointments Necessary
• Professional Fee
• Future Considerations
• Questions and Answers

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Parents Notes Page

• A written consultation provided to the patient at
  the time of the case presentation.
• Ideally developed on no carbon required (NCR)
  paper, in order that a copy can be given the
  parent and the other placed in the record.

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Advantages

• Provides written documentation for the dental
  record of what information was provided to the
  parent.
• Provides the parent with written information with
  which to communicate the childs oral health
  circumstances with the spouse, who may not have
  been present.
• Provides formal verification of the course of
  therapy the parent consented to after being
  informedof informed consent.

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Components

• Findings orofacial soft tissues, developing
  permanent teeth, occlusion, teeth, preventive
  dentistry
• Problems/Goals
• Treatment Planned preventive dentistry, pulpal
  therapy, extractions, space management devices,
  restorations for primary and permanent teeth
• Additional Treatment Required
• Appointments Necessary
• Fee
• Future Considerations
• Date
• Signature

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Demonstration of a Case Consultation