There is a message circulating on the social media that is a cause of great concern and brings into focus the dark side of this new media phenomenon. I am trying to make a balanced statement on why the social media should not and cannot be used to settle personal scores between doctors and patients, especially when it can do unjustified harm to the reputation of the other.
The issue in question refers to the travails of a retired army officer living in coimbatore who claims to be the victim of medical negligence. The message expresses with angst his sufferings with an implant supported denture, done and redone, by two dentists in Coimbatore for which he spent a large some of money. I had the opportunity to see the letter written by the patient on several Whatsapp groups, expressing his angst. I also received a copy of an X-ray ostensibly of this patient's jaws. As a dentist who has been in Maxillofacial surgery for the last 36 years and as a qualified lawyer and ethicist I have a few comments to make. This does not purport to defend or vilify anybody.
1. I do not wish to comment on the treatment per se because I am not an implantologist although I have a working familiarity with the process. Implants are done by another specialist in our practice. However, I can say that the patient's claim about the cost is irrelevant. Implant dentures are costly fixtures and I am sure the patient was informed about the same. The number of implants and how it is engineered are purely technical details and can be justified based on the prevailing situation of bone and nature of prosthesis. There is no such thing as an exorbitant professional fee unless it is sprung on people without notice. That does not seem to be the case.
2. I fully empathise with the patient who is obviously frustrated because some of the teeth on the denture where constantly chipping off. If I had paid 6.5 lacs for a treatment, I too would be frustrated. I am close, in age, to the patient and can fully understand the despair one feels as we grow old with multiple medical problems. However, one cannot justify the act of using social media to name and blame the medical/ dental care giver based on personal opinions.
3. For the lay persons benefit, let me explain what an implant supported denture is. Implants are titanium devices that are planted surgically into bone. They can fail if improperly placed or if the bone condition is unfavourable or due to various other situations. These days, 95- 98% of implants do not fail.
This is followed by loading the implants with a functional denture after 3 to 6 months or sometimes even immediately. These dentures are fabricated in dental laboratories and the teeth on them is made of a costly material which is expected to bear normal bite forces.
4. Having seen the X Ray and CT scans, it is obvious that in this instance the implants have remained intact after 2 years. However, the patient's teeth on the denture were supposedly getting chipped. It cannot be seen on a radiograph but it is a possibility. This can happen due to improper fabrication or by sub standard material used by the laboratory etc. Since the patient complains that it has occurred twice with two different dentists and labs it is unlikely to be due to the laboratory procedure. This can also happen if there are excessive forces acting on the dentures. These forces maybe due to para functional activity of jaws, due to movement disorders like Oro facial dyskinesia, bruxism ( night grinding) or simply hyper function. I cannot comment on what the cause for the chipping of teeth was or on the engineering principles that required the number of implants he had. This is because of my limited knowledge on the nuances of implantology and full mouth rehabilitation. However, I can comment on the line of action the patient chose to publicise this issue, either because of ignorance or despair or both.
5. If the patient assumed that there was negligence on the part of the dentist, he may well be right or wrong. That needs to be decided by experts on the direction of a legal or statutory authority and should be based on evidence based science. There are several provisions within the legal and statutory system to get relief and a due process of law to ascertain medical negligence. I, as the author of a book on medical law and having written several articles on the subject of medical negligence, feel strongly that the gentleman has used the social media as a tool to defame the dentist on the basis of his personal opinion. Medical negligence can only be decided based on evidence that a practitioner has caused injury by failing to meet the standards of care prescribed by evidence based medicine. The Supreme Court has repeatedly reiterated that mere dissatisfaction or the development of a complication does not constitute medical negligence.
6. Under these circumstances the decision to take the matter to the public without any technical input and premised purely on the basis of personal experience or dissatisfaction amounts to subverting the provisions of law pertaining to medical negligence. Directly putting up complaints on the social media drawing attention to the professional abilities of their doctors and imputing motives to their actions amounts to civil and criminal defamation. This is particularly so because the nature of the post appears to be ad hominem ( personal).
My comments are a reaction to an increasing tendency of people to express their angst and targeting medical professionals in a way that affects their profession and standing in society. To do so, if they are indeed found negligent by a court of law, is different from making unqualified judgment based on personal experiences.
The patient, in the above situation, can always go to court or approach the relevant statutory body to obtain relief. It must also be remembered that the doctor who has been vilified has the option of going to court for civil and criminal defamation against the patient for using the social media with the obvious intention of causing loss of face and reputation which the professional might have built up over several decades. This amounts to extra judicial vigilantism in the name of warning the public.
Both doctors and patients must act within their remit, realising that both have rights, duties and responsibilities.
George Paul
Oral and Maxillofacial Surgeon
Consultant in Medical Law and Ethics
