Crossing the line

MDDUS dental adviser Claire Renton examines some common dento-legal pitfalls that can catch out the unwary trainee

AS A NEWLY qualified dentist starting out on your career, the idea of finding yourself in professional difficulty may seem a distant prospect. But as any dento-legal expert will tell you, it can happen to even the most conscientious practitioner.

The best thing you can do is to start as you mean to go on by maintaining high professional and personal standards. This may not guarantee that you won’t sometime find yourself on the receiving end of a complaint to the General Dental Council or some other claim or investigation but it will at least minimise the chances.

When it comes to getting into trouble, the pitfalls generally fall into two distinct categories: actual treatment issues and social or professional issues.

Treatment issues

The golden rule when dealing with patients is: always act in a way that puts the patient first. If you do this then everything else will fall into place. By putting the patient first, you will automatically ensure that your examination and treatment planning is correct and that the patient has a clear cost estimate of the treatment.

This will also mean taking special care in writing up patient records – recording all treatment provided, the taking of consent, warnings given about oral hygiene, advice about treatment options and positive and negative findings. Write patient notes in ink or ball point and never obliterate any of the record. If you need to amend an entry, put a single line through the relevant part and initial the change. The need for clear, comprehensive clinical notes cannot be overstated. If you ever find yourself in court in relation to a dispute over treatment provided, a set of accurate and complete dental notes could be crucial in mounting a successful defence.

Putting the patient first should also prompt you to stay up-to-date with new techniques and materials. The GDC advises all dental professionals to be aware of their compulsory continuing professional development start date, how many hours they are required to do and to plan and record CPD activities accordingly.

You should also ensure that patients have given their consent to treatment. To do this, you must make sure the patient has enough information to make a decision, that they have made the decision voluntarily and that they have the ability to make an informed decision. You can ask someone else to get consent for you but you will still be responsible for making sure – before you start any treatment – that the patient has been given enough time and information to make an informed decision and has given their consent to the procedure or investigation.

And finally, you should respect their confidentiality and only use patient information for the purposes for which it was given. In general, confidential patient information should not be disclosed without their consent. In exceptional circumstances you might be able to justify disclosing confidential information without consent if it is in the public interest or the patient’s interest. Remember that the duty of confidentiality applies to all information about the patient which you learn in your professional role. If it is necessary to release patient information then get the patient’s consent to do so wherever possible; make sure that you only release the minimum information necessary for the purpose and be prepared to justify your decisions and any action you take.

As we all know, not all treatment works exactly as planned. We are working on human beings, not phantom heads and occasionally our well thought-out and executed treatment fails. So how should you respond? Well, the dentist who is putting the patient first would explain to the patient clearly what has happened. Apologise if necessary and, above all, do all you can to make it right. That could mean refunding the cost of the treatment, redoing it where possible, or referring the patient for a second opinion quickly.

If things all go pear-shaped and a dentist is brought before the GDC facing a conduct or performance hearing, the case often boils down to the simple question: did the dentist put the patient first? Those dentists who can show that they acted in the best interests of the patient as opposed to profit or convenience will fare better.

All fairly straight forward so far. So what are the slightly more scandalous things that can land a dentist in trouble?

Drugs and Alcohol

Drugs are a definite “no-no”. Sorry, but there’s no defence with this one. Alcohol is more socially acceptable and while most people will accept that dentists, like many adults, may enjoy the odd glass or three, be careful how you behave when having a drink. You are still a dentist even on your time off and will be judged by what is considered appropriate or professional behaviour. If the council receives a complaint against you and it is decided your fitness to practise is impaired because of inappropriate or unprofessional conduct, your registration could be suspended – or worse. It is also worth considering the risks of treating patients the morning after you have been drinking alcohol, when your clinical skills may not be as sharp as they should be.

The GDC is told by the police if a registrant has been convicted of a crime or cautioned by the police in the UK. They can also consider convictions and cautions imposed abroad which, if committed in England and Wales, would constitute a criminal offence. The conviction doesn’t have to be related to your profession or practice to be considered, and even incidents that happened when you weren’t registered can affect your registration. If you are caught driving under the influence of drink or drugs, for instance, it won’t just be your driving licence at risk. In the most serious cases, you could be struck off and banned from practice.

Sex

I thought that would get your attention! We should all know that inappropriate relationships with patients must be avoided. GDC guidance Standards for Dental Professionals makes it clear by advising dentists to: “Maintain appropriate boundaries in the relationships you have with patients. Do not abuse those relationships.” Healthcare regulator CHRE spells out the risks in greater detail, warning: “The healthcare professional/patient relationship depends on confidence and trust. A healthcare professional who displays sexualised behaviour towards a patient breaches that trust, acts unprofessionally and may, additionally, be committing a criminal act.”

When it comes to relationships with work colleagues, be very cautious.

Recent cases at the GDC have heard intimate details of affairs between co-workers with allegations flying of unprofessional behaviour and potential patient harm. It’s impractical to suggest that staff should never date each other, but it should not be encouraged as it opens up many risk areas.

If you decide to pursue a relationship with a colleague, then make sure personal and professional relationships are kept completely separate. You should not be working together in the surgery so if you are dating one of the nurses, for example, ask to work chair-side with another nurse. If you are the boss and you are seeing a staff member, take extra care as such a relationship could lead to accusations of bullying, harassment or abuse of power. You must not favour the person you are involved with over other employees and equally, it would be wrong to discriminate against a colleague should your personal relationship sour.

Most importantly, you must not use your position in the practice to engage in inappropriate or unwelcome behaviour with a colleague. It’s important to understand how your perception of the situation can be totally different to that held by the object of your desire – especially if they do not share your feelings. As a friend of mine once said, the best advice here is if you begin an affair with someone at work, just be sure it never ends.

For more advice on any of these issues, contact MDDUS, or for more information read the GDC guidance Standards for Dental Professionals at www.gdc-uk.org

 Claire Renton is a dento-legal adviser at MDDUS

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