Dr. Rose, a 65-year-old woman, goes to her six-month appointment for a dental cleaning. Upon arrival, the receptionist requests her insurance card, driver's license, and an updated health form. On the form, Dr. Rose indicates a lengthy list of allergies, including a scrub used for surgeries. The previous summer, after a minor in-office procedure, she discovered this new allergy to chlorhexidine, so she is careful to include it on all her allergy lists.

The dental hygienist, Chrissy, a new 21-year-old employee, inquires about Dr. Rose's profession. When she tells the hygienist she is a registered nurse and a university professor, Chrissy pats her shoulder and says, "Oh, that's nice, dear."

The hygienist instructs Dr. Rose to rinse her mouth out with an antibacterial mouthwash for 30 seconds. While she is having her teeth cleaned, Dr. Rose notices a letter "C" on the bottle of mouthwash and turns it around. It is chlorhexidine, the very ingredient she was allergic to in the surgical scrub. She informs the hygienist immediately and begins to rinse her mouth with water repeatedly.

Chrissy protests and tells Dr. Rose she is mistaken, it is not the same thing, "dear," that scrub is "what you wash your hands with." She pats Dr. Rose's arm again, telling her to be a "good patient" and to open her mouth for cleaning.

Dr. Rose gets out of the chair, grabs her smartphone, points to the surgical scrub and the active ingredient. She uses her albuterol nebulizer and takes a dose of prednisone. Chrissy continues to insist it is not the same substance when the dentist enters the room and asks what is going on.

Between puffs on her nebulizer, Dr. Rose relays the incident to the dentist.

Chrissy continues to protest until the dentist tells her she is wrong, it is the same active ingredient. The dentist offers Dr. Rose a shot of epinephrine, which she declines. Dr. Rose leaves the office as quickly as she can and returns home, grateful she didn't swallow the mouthwash and annoyed by the dental hygienist's condescending behaviors.

Upon arrival at home, Dr. Rose receives a phone call from Chrissy, asking, "How are you feeling, dear?"

1. What are the facts of this case?
2. Review the quality improvement tools in Chapter 7 and select the appropriate one to analyze this problem.
3. What are the top three management issues in this case?
4. What are the legal and ethical obligations a health care professional has to his or her patients and how do they apply to this case?
5. What attribution error did Chrissy make about Dr. Rose? How did that influence her communication with her patient?
6. Who should be held responsible for addressing these problems?
7. What obligations does the dentist have to Dr. Rose