Medical history refusal
Q We recently asked a patient to complete a medical history form (something she has done for us before) but she refused this time, saying we “don’t need to know all of that”. Both the dentist and practice manager tried to explain the importance of having up-to-date medical information, but she could not be persuaded and ended up leaving without having her check-up. It is practice policy to have patients fill out a medical form at least once a year but she asked what regulations state that this should be done. How should we respond?
If a patient refuses to provide up-to-date medical information then this could significantly impact on the provision of dental care. It is correct procedure for the practice to continue to ask patients to regularly update their medical information. This is supported by guidance from the General Dental Council, Standards for the dental team, which states at 4.1.1: “You must make and keep complete and accurate patient records, including an up-to-date medical history, each time that you treat patients.” Similarly, the FGDP’s guidance on clinical examination and record keeping (on p.31) emphasises the importance of checking the patient’s medical history at each appointment where invasive treatment is to be carried out.
Q I am a dentist and would like to take some time out to work abroad for a few months with Dentaid. Would MDDUS provide me with indemnity in the event that any kind of complaint or claim is made against me while I’m abroad?
MDDUS assists members undertaking their professional roles in Scotland, England, Wales, Northern Ireland, the Channel Islands and the Isle of Man. We would be unable to offer benefits outside of these jurisdictions, other than in respect of Good Samaritan Acts, humanitarian work and limited voluntary or expedition medicine. Members can find details of their specific indemnity in the Member Guide and as stated in their individual membership information sheet, which would have been sent with their membership pack. If you do charity/voluntary work abroad, you would need to ensure you have the appropriate registration and indemnity in place for this and it is advised that you contact MDDUS prior to undertaking this work, on firstname.lastname@example.org. It may also be helpful to speak to Dentaid to find out whether they already have appropriate indemnity and registration arrangements in place for their volunteers for the work you plan to undertake.
Q A 24-year-old patient, Ms A, attended the practice to request treatment for a damaged tooth. The soft tissue around the tooth showed some evidence of bruising and minor lacerations. When asked about the circumstances of the injury, she disclosed that she had been assaulted the previous week, but would not go into detail. The dentist encouraged her to report the incident to police and offered her support but she declined (she has capacity). Is there anything else we should do?
As you are aware, a patient with capacity has the right to refuse treatment or interventions. As long as you are satisfied Ms A is not vulnerable or at risk from further attacks then it would be her decision as to whether or not she reports the incident to police. The dentist has acted properly in reassuring Ms A that the practice would support her in whatever way they can going forward. You should ensure that all documentation is factual and accurate in Ms A’s dental records and emphasise that these will remain confidential at the practice.
Q I am considering providing some cosmetic treatments to patients at my practice, and specifically Botox. To reduce overheads, would I be able to bring in a beauty therapist to administer the injections?
It is important to note that Botox is a prescription-only medicine and therefore can only be prescribed and administered by an “appropriate practitioner” in line with section 58(2) of the Medicines Act. There is a risk that you could be personally criticised if a concern were to be raised about the practice of a beauty therapist within your practice, or deemed vicariously liable should a legal claim arise. There may also be implications for your personal membership with MDDUS, which is unlikely to extend cover to a third party (other than providing indemnity for the dental nurses who work within your practice.) We would advise you to exercise extreme caution before proceeding with this plan.
Q I own an NHS practice and was alarmed to read about the Breakingbury v Croad county court case which seemed to suggest I could be held liable for negligent treatment provided by associate dentists. Will my MDDUS membership protect me?
We know that many practice owners have been concerned about this county court judgement, and that’s why MDDUS has added an automatic vicarious liability extension to its GDP practice owner membership grade. We hope this reassures members that they can seek assistance with claims raised against them as a practice owner which arise from this non-delegable duty of care to patients. The extension to the GDP practice owner membership grade is free and automatic. There is no action required by existing members of MDDUS. The vicarious liability extension will also be available to all new individual members who join MDDUS on the GDP practice owner grade and the five year retrospective coverage period will apply automatically as a benefit of membership. Read more in this article.
Q I recently received a fixed penalty notice for speeding, which included three points on my licence and a £100 fine. Do I need to inform the General Dental Council?
The GDC’s Guidance on reporting criminal proceedings confirms that you do not need to inform the regulator of “a fixed penalty notice for a road traffic offence”. We would encourage you to read over this guidance for more detail on the matter.