Rupert Hoppenbrouwers tackles concerns about treating obese patients.
Obesity is on the rise. According to the Health and Social Care Information Centre (HSCIC), in 2015, 27% of the population were obese as opposed to 15% in 1993. Weight issues can be a sensitive topic for some patients, and dentists, rightly, won’t want to draw attention to anything that could make a patient feel uncomfortable.
However, an increasing number of dental professionals are contacting the Dental Defence Union about whether they can safely treat patients weighing more than 20 stone, the weight limit for many dental chairs. They are also often worried that if they do refuse to treat a patient in these circumstances then they may be accused of discrimination.
Dental professionals are right to be concerned about the health and safety aspects of treating obese patients, as they have both a duty of care to all patients and a legal obligation under the Health and Safety at Work Act 1974 to operate in a safe environment.
Using any equipment outside the limits and recommendations of the manufacturer may invalidate your public and employee liability insurance and you may find you have no recourse against either the manufacturer or the patient for any breakage or failure. Under the Unfair Contractual Terms Act 1977, liability cannot be avoided, even if the patient is informed and voluntarily accepts the risk.
This means a dental professional would be justified in referring patients to a specialist unit for treatment if they cannot be treated safely in the practice.
Obesity and equality
It is important that dental professionals are aware of their legal obligations when it comes to accommodating obese patients and ensuring they have access to dental care.
While a European Court ruling found that obesity is not itself a protected characteristic or a disability, it also stated that any disability arising from obesity would qualify as possible grounds for discrimination, regardless of how that disability arose. Obesity is associated with a range of health concerns which might be considered disabling, including joint damage, cardiovascular disease, type II diabetes and cancer.
Under the Equality Act 2010 and its statutory Code of Practice, service providers are expected to make ‘reasonable adjustments’ to ensure that disabled persons are ‘provided access to a service as close as it is reasonably possible to get to the standard normally offered to the public at large’. The disabled person must be at a ‘substantial disadvantage’ and this can be addressed by the provision of a ‘reasonable alternative’.
What are ‘reasonable adjustments’?
Of course, what’s reasonable will vary according to the type of service your practice provides, your size and resources and the effect of the disability on current and future patients. For example, a specialist bariatric dental chair might easily be considered an excessive burden on a small dental practice but might be an appropriate purchase for larger practices with more patients. Although it’s worth bearing in mind that if the cost of the chair reduces in future, it might be considered reasonable for smaller practices to buy.
It makes sense to keep documentary proof of the assessment you have carried out to accommodate patients with disabilities and what reasonable adjustments have been made. This will mean you can demonstrate compliance with the legislation if asked to do so.
Referring a patient
If a dental professional believes a patient cannot be treated safely, the practice will still need to make sure the patient has access to ‘a reasonable alternative’ for their dental care. This usually means referral to a specialist unit.
Your local area team or health board should be able to advise you about available provision and it is ultimately their responsibility to ensure that suitable arrangements are in place for patients in their area to receive necessary dental treatment. This will often be in a community or hospital setting.
Sensitivity and tact are vital when explaining the position to obese patients and it’s important that all members of the practice team, including receptionists, are aware of how best to broach this difficult topic. Choosing a private setting to discuss the situation can avoid embarrassment and a potential breach of