Ethics & Law · patient case question
Considering the whole picture — the hostile caregiver, the withdrawn patient and the unexplained bruises — what should the dentist do?
Patient case: Elderly patient with unexplained bruising
Patient: Male, 85 years old
Chief complaint: Presents for a routine recall examination, accompanied by his son and daughter-in-law.
History: Rheumatoid arthritis, managed with ADALIMUMAB and ASPIRIN. Lives with his son. During the appointment the son answers most questions for the patient, is visibly angry and speaks to him harshly.
Findings: The patient is withdrawn and quiet, offering little spontaneous speech. Several bruises of differing ages are visible on both forearms. Oral examination is otherwise unremarkable for his age.
Show answer and explanation
Correct answer: A. Report the suspicion of elder abuse to Adult Protective Services
- A. CORRECT. Dentists are MANDATED REPORTERS of suspected elder abuse. The legal threshold is REASONABLE SUSPICION, not proof — you are not required to investigate or confirm anything before reporting. A hostile caregiver who speaks for the patient, a withdrawn affect and unexplained bruises of varying ages together clear that threshold comfortably.
- B. Documentation is necessary but not sufficient. Charting the findings while failing to report does not discharge the mandated-reporter duty, and in most jurisdictions the failure to report is itself an offence.
- C. Confronting a suspected abuser, particularly in front of the dependent patient, can provoke retaliation once they leave the office. Investigation and confrontation belong to the protective agency, not the dentist.
- D. Deferring to the next recall leaves the patient in the situation for months. He may not return, and abuse tends to escalate. Delay is not a neutral choice here.
Note: Note the contrast with intimate partner violence in a competent adult, where the usual first step is a private conversation with the patient and reporting generally requires their consent. For ELDER and CHILD abuse, reporting is mandatory on suspicion and does not depend on consent. Do interview the patient alone if you safely can — but that supplements the report, it does not replace it.