The ADA appreciates Dr. Pallasch’s concerns. However, the Association Report on Antibiotic Prophylaxis is a judicious weighing of the benefits and risks of antibiotic premedication of dental patients with total joint replacements. It is based on currently available scientific information and the opinions of experts in fields of medicine and dentistry. New scientific information is always welcome and will be taken into account during the next revision.
Dr. Pallasch refers to the "legal perspective" associated with the report. The Division of Legal Affairs believes some clarification is warranted.
Dr. Pallasch concludes that a physician is unlikely to testify against a dentist regarding the appropriate standard of care applicable to the dentist. While that conclusion may be debatable, specifically with respect to the issue of antibiotic prophylaxis, the point of the article was not that the physician would testify as an expert witness. Rather, there is a risk that a physician would testify to the fact that his or her recommendations were not followed by the dentist. Whether this falls below the appropriate standard of care would be a question presented to the jury to decide based on this and other evidence, including expert testimony.
Dr. Pallasch also may have misapprehended the article’s statement that, where the patient’s choice of treatment runs counter to the dentist’s professional judgment, the dentist may have to refer the patient to another provider. The point was not to recommend routine referrals of patients to other dentists, but that such a referral may be a dentist’s only recourse when the patient will not allow the dentist (in Dr. Pallasch’s phrase) to "do the right thing."
Finally, the Legal Division respectfully disagrees with Dr. Pallasch’s suggestion that informed consent may be harmful and lead to an increase in civil lawsuits. A patient has the right to be fully informed of the treatment options available and their respective risks. Informed consent is, of course, designed to protect dentists in the event of a civil lawsuit.
