Bad Teeth

There is a strange and horrible story in the HoS and in the Herald today about an 8-year-old girl who starved to death in the UK, because she had extreme dental phobia. Apparently she developed this phobia after her baby teeth became loose, eventually having to have all her baby teeth removed under general anaesthetic. She refused to eat and drink afterwards and eventually died of kidney failure from dehydration. It is a bizarre and disturbing story. 

The coroner is reported to have said  that “doctors failed to diagnose properly” the child’s illness. I find that very, very hard to believe. For dental surgeons to go to the extreme step of removing all a child’s baby teeth under anaesthetic, the girl would have had to undergo extensive psychological assessment to establish that there was no other option. The problem would have had to have been occurring for many, many months, if not years. Her teeth would have had to have decayed substantially to lead them to remove them all. I find it impossible to believe that the doctors would not have appreciated the severity of her phobia.

No, the real problem here occurred at follow up after surgery. In the parents own words:

“She was sent home a few days later but would not eat and died three weeks after the operation.

“Her parents said they contacted doctors and a psychologist but no one saw Sophie in person before she died. (emphasis mine)”

This was unlikely to be a doctor stuff-up at all. This was probably a NHS outpatients failure. The girl should have been followed up at a week in outpatients. A routine follow up appointment would have been made by the doctor and sent to the patient. Alternatively, they might have scheduled a six-week follow up and asked the parents to follow up with the GP in the meantime. In which case the failure was in the speed the discharge summary was sent to the GP (should be within a day or two but often extends to weeks due to the business of house surgeons and the scarcity of typists).

These errors are system errors rather than a doctor’s judgement error. Though I am speculating here, because I don’t have all the facts, I am fairly sure I am right. What really concerns me here is that, as usual, the doctor’s have been blamed, but nothing has been said about the parents role in all of this. I have two questions to the parents.

1. What, exactly, did they tell the doctors and the psychologist when they phoned them? It seems very strange that none of them asked to see their daughter.
2. Why did they not take their daughter to see their GP during those three weeks?

The parents of this child seemed to have exhibited a distressing lack of insight into their daughter’s health. This is not to try to “blame” them for their daughter’s death, it is simply to point out that this strange and tragic death is, once again, multifactorial in nature. Coroners do not like multifactorial answers. They much prefer the simplistic “Doctors failed to diagnose properly” judgement.

Even though it does not tackle the real problems in the case.

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