Features and Medicolegal Implications of Diagnostic Omission for Oral Squamous Cell Carcinoma

Dentists play an oversized role in screening and detecting oral cancer. But are we living up to that responsibility? In this article, Albano et al highlight the importance of oral cancer screening, detection, and treatment as well as how early detection significantly impacts the outcomes. Among patients with newly diagnosed oral squamous cell carcinoma, 70% are diagnosed in the late stage (III or IV), thus decreasing the 5-year survival rate to below 40% compared with early detection in stages I and II with an 80% or greater 5-year survival rate. This is a meaningful difference in survival outcomes. As dentists, we see our patients more frequently, often every 6 months, than our physician counterparts. This gives us an opportunity to help educate our patients and screen and detect oral cancer earlier. Are we doing this for all our patients at every visit? If we are, are we communicating that to our patients and documenting the screening? This brings up important medicolegal issues and the adage “if it’s not written down, it never happened.” This study noted that the most common reason for oral cancer malpractice cases is due to a failure to diagnose, with several studies showing the compounded significance of poor documentation in these cases.

What can we do to protect our patients and ourselves?

• Oral cancer screenings are part of the standard of care, and dentists should be doing them at every comprehensive and recall exam, at the minimum.
• Communicate with our patients and tell them “I am going to do an oral cancer screening” and describe what we are going to do.
• Document the oral cancer screening:
  • The findings should include the duration/history of the lesion, medical and behavioral histories, differential diagnosis, and management, including appropriate follow-ups.
  • Describe the lesion in terms of size, color, consistency, shape/morphology, and site. Take photographs.
• An internal dental code for an oral cancer screening could be created that is coded out each time we complete it with a zero fee, thus showing up on the patient’s walkout statement and/or bill.

Together, we can help increase awareness, with the goal of reducing late-stage diagnoses. Never underestimate the impact you can have when performing an oral cancer screening. You can literally save someone’s life.