Whatever the outlook of an individual dentist entering general dental practice for the first time, there are clearly both risks and benefits associated with taking this step.
Identifying those risks and learning how to manage them will be of interest to those taking up VT positions (VDPs), other members of the team who will work with VDPs, and possibly also to those making the transition from trainee to associate.
So, at this stage you might be expecting a long and detailed explanation of the importance of thorough record keeping but, fortunately for you and I, this is already covered very well in MDDUS’ online tools, including interviews and checklists, leaving me free to wander other paths less well-trodden.
Any sensible risk management strategy starts by trying to identify the potential risks involved in the activity. Experience and case studies suggest some recurring themes posing possible hazards for those entering practice, and these often relate to:
- Unfamiliarity with NHS regulations
- Knowing your limits
These factors potentially interact to multiply the risks involved. Imagine, for example, a scenario where a patient requires removal of an impacted lower third molar. The VDP correctly identifies the indications for removal and explains the procedure and risks to the patient who verbally consents to the procedure. However, they are unaware of the fees involved and do not provide a written estimate. What if they also decide that verbal consent seems clear enough and do not obtain written consent specifying the risks involved? What if they have not discussed the procedure with their nurse beforehand and are unaware that the nurse has no surgical experience? What if they then decide to go ahead and remove the tooth because, after all, they have 30 minutes free until their next patient arrives and they have assisted with a few cases like this as a student?
There are numerous strategies available to minimise the chances of this kind of nightmarish situation and they largely relate to the bullet points above.
Firstly, I would encourage VDPs and new associates to study the Statement of Dental Remuneration (SDR) until they are fully conversant with its Byzantine details. I advise this with a heavy heart as it is never something I have read myself with any degree of enjoyment. I have, however, appreciated the feeling of relaxation – while discussing treatment plans, estimates and the need for prior approval with patients – that comes from having put in the spade-work of learning the regulations. If you are reading this as a student without yet having heard of the SDR – don’t worry – your trainer and adviser will be introducing you to its delights soon enough.
In my opinion, and admittedly it can not be proved either way, the most effective way of staying out of trouble is through open and honest communication. Patients are human beings who quite reasonably want to know if there are different options for their treatment, what procedures are involved in providing it and how much it is going to cost. In relation to the last of these, when, during the VT year, patients are given the opportunity to assess how the VDP has communicated with them, the only factor that comes up frequently as an area for improvement is that they would rather be clearly told how much their treatment is likely to cost. So, for VDPs to get ahead of the game, they should make a point of giving cost estimates from day one as this has the potential to significantly reduce complaints.
The importance of communicating clearly certainly extends to how you interact with your colleagues and for VDPs the key players are the trainer and the nurse. The VT adviser can also occasionally be of some use. All of these people are best regarded as colleagues to the VDP as opposed to bosses, staff or mangers. Each has their own perspective on the challenges VDPs face and can provide their own brand of advice and support on clinical and non-clinical matters. This “support team” is unique to the first year in general practice and so it is hugely important to take maximum benefit from it.
When it comes to knowing your limits, graduates entering general practice should consider the Dunning Kruger Effect (go look it up!). Put simply, this psychological phenomenon means that if you think you’re really, really good then you may well be a dumpling. Think about some of the auditions in Britain’s Got Talent… One strong antidote to this effect is to seek out and welcome feedback from others and there are plenty of opportunities for this during VT.
Similar risks exist for those entering associateships for the first time – and the solutions are also unsurprisingly similar. For example, dentists at this stage in their career may even have had overly supportive training practices who have sheltered them from the realities of NHS “paperwork” and so some revision here could be beneficial. Remember also that “independent practice” does not mean “alone” and it is important to keep communication and peer-review active within the practice as well as through CPD and memberships of societies etc.
If all this talk of risks seems a bit daunting, it is worth bearing in mind that figures show VDPs and dentists up to five years qualified are relatively “low risk” in terms of complaints and claims reaching the defence union. It is also reassuring to know that MDDUS is an excellent source of informal advice for managing any minor issues as they arise – and yes, I know that is true from personal experience and do not just say it here for diplomatic purposes.
In summary, dentists embarking on their adventures in general practice should be aware that they are relatively unlikely to encounter major problems, should minimise their risks by communicating openly with colleagues and patients, and should be aware of the many sources of support available to them. In other words, they should relax and enjoy it.
[The views expressed in this blog are my own and do not necessarily represent the opinions or policies of MDDUS or any other organisation I work with/for]