THE READERS' CORNER

This month's topics are dietary recommendations and medicolegal issues.

1. What dietary recommendations do you offer to young patients? to adolescent patients? to adult patients?

The respondents were fairly consistent in their recommendations. Sugary foods, sticky foods (caramel, bubble gum), and hard foods (raw vegetables, fruits, candy, ice) were listed by all as items to avoid. Few practitioners differentiated between young, adolescent, and adult patients. Some of the readers did not give out lists of foods to avoid at the beginning of treatment, preferring to address specific problems as they arose.

What nutritional instructions do you give to young patients? to adolescent patients? to adult patients?

Fewer than 20% of the orthodontists reported giving any nutritional instructions to patients. Occasional mention was made of the use of vitamin supplements and the need for a balanced diet, including vitamin C.

Do you suggest foods and recipes to patients with new appliances? patients with removable appliances? patients with archwire changes? surgical patients? TMJ patients?

Only a few respondents reported suggesting foods and recipes. The I Hate to Chew Cookbook from Straight Status was mentioned as helpful by two practitioners. A soft diet was occasionally recommended for TMJ patients.

Specific comments included:

"My feeling is that they can eat all the sugar they want if it won't break the braces and if they brush and use a fluoride supplement."

"We give Super Smiles from Behavioral Motivators to children and It's Up to You from Zulauf to adults."

"We use the film Adult Braces from the Video Education Company of America to provide additional recommendations."

"When a patient first has appliances inserted, we suggest they get a good meal fast because they will have several days of soreness. We recommend the acquisition of a food processor for 'tough times'."

2. What is your current total amount of malpractice coverage? your monthly premium? type of coverage?

Forty-five percent of the clinicians said they had an occurrence-type policy (future coverage for present cases), while 55% had claims-made policies (coverage for current year only). The amount of coverage reported varied widely, from $200,000/$600,000 to $1 million/$3 million. By far the most popular level of coverage, particularly for claims-made policies, was $1 million/$3 million, for which the premiums ranged from $1,205 to $7,200 per year.

There was no obvious difference between the costs of occurrence and claims-made policies, but there were wide variations in the premiums being paid for similar amounts of coverage. Several practitioners were paying the same premiums for claims-made policies with half the coverage of other practitioners' occurrence policies. With this small a sample it is impossible to draw definite conclusions about the reasons for the variations, but New York and California did appear to have higher premiums than other states.

Do you maintain complete pre- and post-treatment patient records? How long do you keep patient records? Do you have a system for retrieving "dead" files?

More than two-thirds of the respondents reported keeping complete pre- and post-treatment records. A few said they kept complete pretreatment, but spotty post-treatment records. Almost all said they kept their files "forever"; the few who did not reported storage periods of about 15 years. All had some sort of retrieval system, although the methods varied widely.

Do you use informed consent forms?

More than 95% of the practices used informed consent forms for all their patients. About 60% made their own forms, often on computer, with some standard and some variable paragraphs. Most of the remainder used forms produced by orthodontic societies with the practitioner's letterhead added. A few used commercially produced forms. The majority of forms were one page long, a few were two pages, and about 20% were longer, often in booklet form.

Comments included:

"My current malpractice policy is $1 million/$3 million, and the annual premium is $2,400. This is for a claims-made policy and reflects a 10% reduction for having taken a 'risk management course'."

"We use a log with the patient's names and case numbers kept in the order they were first seen. Models and records are placed in boxes, which are lettered and numbered. A note of these codes is placed next to the patient's name in the log when they are 'dead' files."

"Previously active patients are all numerical in our system. So we simply remove a number sequence from our files (alphabetic would be a headache!). Retrieval is via Acme Visible listing. 'Dead' files are kept separate from active patients."

"Active files are maintained alphabetically. When a patient becomes inactive, however, a number is assigned and the files are filed numerically. A 3" x 5" index card is made out with the patient's name and 'inactive number' and filed alphabetically in a card file. Additionally, a numerical listing is kept in a bound notebook."

"We keep all 'dead' file models and records in a rented storage space ($50/month) about 2 miles from the office."

"Our 'dead' files are sealed in plastic containers every five years. Retrieval involves finding the five-year section from a master list."

JCO wishes to thank the following contributors to this month's column:

Dr. Richard Alston, Wichita Falls, TX

Dr. Michael Baron, Branford, CT

Dr. Al Bishop, Bedford, TX

Dr. Stuart Bisk, San Pedro, CA

Drs. Raymond Black and George Davis, Richmond, VA

Drs. Jerry Capps and Richard Moulton, Atlanta, GA

Dr. John Coker, Fredericksburg, VA

Drs. George Carofino and John Gargiulo, Torrington, CT

Dr. Donna Ebert, Fort Collins, CO

Dr. Gary Engelking, San Jose, CA

Dr. Steven Ira Fein, Kingston, NY

Dr. James Gillig, Canton, MI

Dr. Wayne Hickory, Ellicott City, MD

Dr. Roland Neufeld, Redlands, CA

Dr. James Nicholson, Indianapolis, IN

Drs. H.A. Osborne and M.J. Bernard, Canton, OH

Dr. Charles Redmond, North Little Rock, AR

Drs. John Rogers, Terry Duncan, and James Dillehay, Wichita, KS

Dr. Jerome Schechter, Allen, TX

Dr. James Soltes, Hickory Hills, IL

Dr. Robert Williams, Mountain View, CA