Dentist said he'd report me

[Shmee1988]

So, my son is 13, he has adhd and suspected autism (awaiting assessment). Unfortunately his adult teeth have not grown straight at all. Some are almost twisted in his mouth and some have erupted on top of others. He was referred to an orthodontist 3 years ago. The wait list for NHS treatment is loooong and he finally had his first appointment yesterday. He is not thrilled at the prospect of braces but after alot of discussion he has realised its important and ideal to get it all done whilst hes still at school when some of his peers will also have them. The orthodontist did all of the Xrays and said he needs braces and qualifies for this on the NHS. He then turned to my son and said 'would you like braces?' to which my DS replied 'no'. The orthodontist then said he woukd need to see us again in 2 years time as my DS doesn't want braces so he wont fit them. I asked to have a private word with him and explained that part of DS sen is that he is very literal and that when he asked him if he would LIKE braces, he answered the question literally as if he was being asked if he would like to have to have braces and that he was not refusing treatment. He didn't care and told me that I need to start the referral process all over again and that it would be almost 5 years before he can get them fitted on the NHS due to the wait time. I asked him if I could have another word with DS so that son could explain he wasnt saying he wouldn't have them and he said no. He then went on to say that if I bought my son back and he still said he wouldn't like braces, he will report me. I thanked him for his time and left but I was so upset. Ds was upset and now that upset had turned to anger. Is he suggesting that advocating for a child to receive necessary treatment is akin to abuse if the child is anxious about it? Aren't all kids anxious about braces? I want to take this further and complain. Especially as my son will be almost an adult by the time his next appointment comes around. Opinions please? Thanks in advance.

Gillick competency is a far more comprehensive conversation than 'do you want braces?'

It is not specific to age - different children will have different capacity to consent or refuse dependent on many factors.

It also has to be related to the complexity of the procedure and it's likely consequences - anything with signicant side effects need to be explored as to whether they fully understand the choice they are making.

It is being used wrongly in this situation and many many others. It seems to be just easier for HCPs to ignore the parents and manipulate relatively young people.

I wasn't present in the surgery so I can't comment.

However, respect for young people’s views is important. If a young person refuses treatment, those involved must carefully weigh up the harm it would cause to their rights by overriding their refusal, against the benefits of treatment.

All decisions must be made in the best interests of the child or young person.
These are often complex situations requiring a multi-disciplinary approach - including involving child protection services in some cases.

The law on parents overriding young people’s competent refusal is complex and varies around the UK

My son was asked exactly the same question by the Orthodontist and replied 'Well not really', and my son isn't SEN. I said to the Orthodontist, 'No child wants braces'. I think this is a standard question that's asked. My friend's daughter was asked the question by the same Orthodontist as my son. Thankfully, the Orthodontist wasn't stupid enough to take the answer as a refusal for treatment. Clearly your son's Orthodontist has done exactly that.

I am convinced orthodontist are minions of the devil, why are they so mean and rude?? If you hate people on NHS don't take them. I am sorry you had to deal with it. They took DS braces last weekend and without exaggeration it was the best day of this year for me. BAD BAD people (I am aware I am generalising and I am wrong, I don't care).

@user1471538275 It is being used wrongly in this situation and many many others. It seems to be just easier for HCPs to ignore the parents and manipulate relatively young people.

For what purpose ?

The dentist isn't a mind reader.

Then maybe he should ask the question he actually wants the answer to?

Rather than trying to read minds.

It was ridiculous question and you should complain and do what you can to insist on treatment now.

if I as an adult with no additional needs was asked ‘would you like a filling?’ at my next appointment the truthful answer would be no. Obviously I’ll say ‘ooh I’d love one yes’ because i understand what the intended meaning of the question is. But to ask that of any child, let alone one with SEN is really poor and lacking understanding of accessibility needs etc.
in fact is be throwing that into the complaint.

It is literally in the GDC's own standards for obtaining valid consent

https://standards.gdc-uk.org/pages/principle3/principle3

In this case it seems like the dentist wanted to bump an NHS patient with additional needs off his waiting list.

That's ridiculous. You could report him right back!!

That’s shocking, OP. Sounds like disability discrimination. The dentist did not take your DS’s capacity and communications needs into account and did not adjust for them, even after you’d explained the situation in person.

Are there any charities you’re involved with for DC’s ADHD and autism who may be able to help?

But he is not, is he? The son didnt refuse to consent to treatment, his mum explained he had answered the question literally, "would you like braces". A reasonable professional with a knowledge of how to behave with non neurotypical patients would understand this and adjust, not just refuse to check their understanding.

Definitely contact pals. I'm not saying your son needs it, but for examples of how to communicate, you should look up examples of hie to communicate in capacity assessments.

Jeez Louise the Dentist sounds like a twat. I’m terrified of the dentist but went last week and have two follow up appointments for a deep clean with local anaesthetic. If she’d asked me did I WANT the deep clean then my honest answer would be no too, but I know I need to have it, as your DS does!

I think your first port of call is a conversation with the practice manager, explain the situation and ask if there is a different orthodontist that you could have a second opinion appointment with. This might not be the first complaint that they've had about his manner...

The dentist is discriminating against your son. Anyone with half a brain understands the difference between the questions “do you want braces?” And “do you consent to braces?” A person with ASD of any age will absolutely answer those questions differently.

as an adult with ASD I might say, “i don’t want braces, but i understand that i need them” as a response, but i can’t be imprecise.

This.

@Littleblueridinghood yes, you were not in the room so you can't universally declare the dentist was following the correct procedure - but you did.

I totally get your son. I will never forget when I was about 5 going for tea at a friend's house. Her mum asked me if I liked cucumber and I said "yes". She frowned at me and barked "yes PLEASE!"

My mum explained to a tearful me that people don't always mean the exact thing they say.

I'm still very literal. I don't have a diagnosis.

Sorry - that was far too brief a reply . The orthodontist is not following proper protocol .
He should be working with you and your son to ensure he ( the orthodontist) properly understands your son’s wishes after you have explained that your son answers questions in a very literal way .
You don’t appear to be coercing your son to undergo orthodontic treatment . From what you’ve posted he can see the benefits of and desires the outcomes of a properly functioning occlusion .

That is unbelievably frustrating, especially after a long wait.

I would start by acting under the assumption that the orthodontist thought he was practicing appropriate consent protocol but has a piss poor understanding of autism and is shite at recognizing in the moment when he's got it wrong. Contact the practice manager and explain the situation from this point of view, with an attitude that says "I know everyone meant well and this was an honest mistake that I have no doubt you'll be eager to help fix." Either email or call and then send a follow up email referencing the date and time of the call and summarizing what you said. I'd go with some version of "I'm sure this orthodontist was focused on the importance of consent, but not making adjustments for my son's disability has unfortunately kept him from accessing appropriate treatment due to his disability. Here's the background information that was missing and my specific request for how we can fix this."

It's entirely possible that the orthodontist was just looking for a reason to refuse or that the practice will dig their heels in to avoid being wrong about something, but there isn't anything to lose by starting with this approach and it's often far more effective than jumping to the formal complaint stage. You can always escalate when the "Hey, I view us as being on the same team so let's solve this mixup together" approach doesn't work but it's almost impossible to de-escalate and find a cooperative relationship after going the angry complaint route.

Sounds like the orthodontist just wanted to get rid of another patient from the NHS waiting list. Worth trying to sort it out now otherwise you will find he will have to pay for private treatment later.

My son has ASD and goes to a specialist dentist, doesn't sound like this one has a clue. Is it possible to look for a specialist dentist in your area? Some of the facebook parents groups for ADHD etc might know?

Disgraceful.
Absolutely complain.
Self report to SS and tell them exactly what he was asked.
Absolutely disgusting behaviour from a dentist that clearly has form.
No child wants bloody braces, they are a dose.
But they are capable of seeing the larger picture and accept they are necessary.

You stated clearly your child has SEN.
I am furious on your behalf.
I really consider what he has done needs reporting to multiple bodies.

I would take it he deliberately threatened you with reporting you, to intimidate and shut you down.

I would be asking specifically onnwhat basis.
He asked would he "like" not "want".

You need to be a completely nousy PITA about this.

So upsetting for you and your son.