A request to record inaccurate periodontal data and sign an insurer's form

Refusal is her right; an inaccurate clinical record is not.

1. Establish what she is actually refusing - full charting, or the treatment, or the conversation? Often it is the last. Offer a compromise that preserves clinical safety: a six-point chart of the sextants with pockets ≥4 mm rather than a full chart, and a single quadrant of debridement today to see whether she tolerates it.
2. Give the information a reasonable person needs, concisely and without moralising: she has generalised periodontitis with 6 mm pockets, bleeding and smoking; untreated it progresses, and tooth loss is a realistic outcome; smoking and her HbA1c both worsen it; treatment is manageable and staged.
3. Record the refusal properly - the diagnosis, the treatment offered, the risks explained, the patient's stated reasons, and that she was invited to reconsider. This protects her (she can return) and you (the record shows the standard of care was met).
4. Do not abandon her - refusing periodontal treatment does not mean refusing all care. Continue caries prevention, smoking cessation advice (Ask, Advise, Act; refer to a stop-smoking service), and oral hygiene coaching.
5. Her emigration is not a reason to compress or falsify care - six weeks is enough for a course of non-surgical therapy if she consents, and a referral letter to a dentist abroad is a legitimate and helpful action.

Refuse - clearly, briefly and without negotiating the facts.

• The statement would be false. No periodontal treatment has been completed. Signing it is not a 'favour' or a documentation shortcut; it is dishonest certification that could constitute fraud, expose you to regulatory action and jeopardise your registration, and harm the patient by creating a false record that future clinicians will rely on.
• What to say: 'I can't sign that, because it isn't accurate. What I can do is complete the form truthfully - which will say assessment was offered and declined - and I'll write to your insurer if a factual letter would help.' Offering an honest alternative is more professional than a flat no.
• Offer truthful routes: return the form with the factual position; provide a treatment plan and costs so she can approach the insurer for an upgrade; suggest she speaks to the insurer about limits.
• Document the request and your response in the record, factually and without judgement.
• Escalation awareness: if a colleague asked you to sign it, or if pressure continued, you would raise it through the practice's governance route - this is the same principle as any request to falsify a claim.

Use a motivational, autonomy-supporting approach rather than a warning-heavy one.

• Ask permission before advising: 'Would it be alright if I explained what I can see and then you tell me what you'd like to do?'
• Reflect her stated concerns - cost, time, dislike of being lectured - and address them directly by offering a staged, priced plan with an itemised estimate.
• Avoid shame language around smoking and plaque; smoking is an addiction, not a character flaw. Use Ask–Advise–Act and offer a referral rather than a script.
• Use her own priorities - she is emigrating; framing periodontal stability as something that protects her teeth while she establishes care abroad is more persuasive than population-level risk messages.
• Close the loop: summarise the agreed plan, give it in writing, and agree a review date. A patient who refuses today and returns in a year is a better outcome than one who never returns.
• End the record entry with the plan and the invitation to return, so any future clinician sees a coherent, non-judgemental standard of care.