Ethics & Law · patient case question
You decide to use a higher-grade material than the one quoted, at no additional cost to the patient. What should you do?
Patient case: The business of the practice
Patient: Practice and population-level scenarios
Chief Complaint: Not applicable.
Background: A prescription is being written for prophylaxis. The practice insurance portfolio is under review. Rising floodwater is entering the building. A crown is being placed in a better material than quoted, at no extra charge. A patient irradiated for a head and neck cancer ten years ago requests an extraction and refuses radiographs. The local council is consulting on water fluoridation. A published cohort study is being appraised.
Findings: Not applicable.
Show answer and explanation
Correct answer: B. Inform the patient of the change and that there is no additional charge, and document it
- A. Billing an insurer for a material the patient was not charged for, and routinely waiving the patient's co-payment, moves into territory that carriers treat as fraud. Bill what was agreed and what was provided.
- B. CORRECT. Consent is given to a SPECIFIC treatment plan, and any material change to that plan belongs to the patient — including a favourable one. Telling them respects AUTONOMY and VERACITY together, removes any possibility of an unwelcome surprise later, and ensures the record accurately reflects what was actually placed, which matters for any future clinician and for warranty or replacement. Say it plainly: what changed, why, and that there is no extra charge.
- C. Silence assumes the only thing the patient could care about is the bill. They may have their own reasons — a known material sensitivity, a preference, advice from another clinician — and an undisclosed substitution damages trust out of all proportion to the benefit when it comes to light later.
- D. The insurance carrier is not the party whose consent is required for a change in the patient's treatment. The patient is.
Note: The free-upgrade scenario is the addition, and the principles engaged are autonomy and veracity together. The practical rule: no surprises, even pleasant ones.