DUE DILIGENCE, DO NO HARM, DUTY OF CARE
The immovable Trinity that governs our thoughts as we attempt to provide Care for patients. However, considering there are three statements that have to be applied to the three entities of Patient, Dentist and Team, it might be worth considering what and how we are thinking and proposing as we prepare to treat and care for our next patient. The current environment where we are obliged to work, has highlighted this important decision-making position once again.
DUE DILIGENCE
In assessing the problem presented by the patient, have you listened, questioned and observed, completed the exam and special tests, and considered the gold standard/ ideal Treatment Plan. Have you then discussed with and informed the patient of all eventualities and presented an acceptable treatment plan? Does the Ideal Gold Standard Treatment Plan work in this case, or should you agree a alternative or compromise treatment. Should you be doing nothing or perhaps referring to provide appropriate care? Choices and Decisions.
DO NO HARM
To whom does this refer? The Patient and their problem, the Dentist, or The Team, all of who may be exposed in various ways. This may not necessarily be due to a failure or success of the treatment itself, the level of care provided, a potential risk of cross infection or the myriad of other unforeseen events that happen, but had not been assessed. Who needs to be protected from whom and from what? Maybe a fourth discipline needs to be added to the Trinity, that of Risk Assessment.
DUTY OF CARE
It is generally considered that as practising dentists we should treat the patient who arrives at our surgery. However, it may be that there are circumstances that allow us to refuse, particularly in a situation where we believe that another colleague would be better qualified to provide that patients care. Are we providing care or treatment? What is it that is going to bring the patient back? The treatment that took 15 minutes, or the care spread over days or even weeks in providing suitable planning, a comfortable and appropriate environment and the backup of a professional team, before during and after treatment.
The current environment presents situations where the patient may not know that they are infected or are a carrier, and that situation may also apply to any member of the team. Being unaware of information that is withheld by the patient could compromise the dentist and team, financially or for health reasons. The use of disclaimers and correctly informed consent forms will not always protect you. Failure to carry out Due Diligence on the part of the team is a reason where we will fail ourselves. The treatment is only part of the care.
Return to the start and ensure that at all times you have asked the patient, listened to the patient, recorded contemporaneous notes, carried out Due Diligence, and agreed about Informed Consent. Ensure that the Patients Forms have been initialled and countersigned. Whereas in any situation if a patient claims they are wronged, even a high level of due diligence and risk assessment and signed forms may not cancel out a claim, but may go towards mitigating it in some way.
Is this the time to review the whole issue of Patient and Dentist responsibility for the success and failure of treatment. It seems strange to me that a failed implant is said to be worth a five-figure sum of money even when patients have been advised that there is a limited lifespan for any Dental Treatment.
Angus P Roche PositivePractice.ie
INSPIRED BY LIFE IN DENTISTRY JUNE 2020
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