Making assumptions can have serious consequences, as this cautionary case illustrates.
A patient visited a dental practice complaining of sore gums. His regular dentist was not at work on that day and the receptionist informed the senior partner of the problem.
The dentist did not bother to examine the patient but noticed from the record card that he had suffered from periodontal disease for a long time and informed him verbally that this was likely to be a recurrence of the same problem. He gave the patient a prescription of metronidazole.
Unfortunately, the patient’s medical history was not checked and in fact he was on long-term high-dose warfarin therapy. The antibiotic potentiated the action of the warfarin and led to the patient being hospitalised and needing an emergency transfusion.
The partner sought advice and it was agreed that he would arrange to see the patient for review and explain the problems that could result from a prescription of this type of antibiotic despite it being a drug commonly used to treat periodontal disease. The patient took no further action.
Learning points
This case illustrates the importance of undertaking a clinical examination wherever possible to confirm that the prescription was a justified treatment and also the need for careful consideration of the patient’s medical history at each appointment and consider possible drug interactions.
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