Mid-Summer and settling into a fairly simple life trying to avoid danger, and making various efforts to keep fit, sane, and safe. COVID-19 is here to stay for the foreseeable future.
So, what is the first thing you are going to do if you have to see a patient after your phone triage, examination, and history taking? Do a risk assessment, and be sure that the patient, yourself and your staff (THE TEAM) are fully cognisant of all the potential outcomes, with the current provision of Dental Care. Dental Care implies looking after the patient with whom you are going to carry out treatment. Is the treatment the correct treatment and is it within your skill set, and are you and your patient on the same wavelength and understanding each other. Do no damage!
DECISION
At any appointment, with all patients, you should be making a decision of how you are going to treat this patient at that appointment. Do you feel, with an overall risk assessment, that it might be better for yourself and this next patient not to continue? There is an ethical issue here. Regardless of what you agree to do, treat or refer, whatever the option that is agreed, then Be Prepared.
Remember you are treating this patient but is it compromising you and your team? Can you adapt without having to change your protocols?
MISTAKES
A mistake is doing the wrong thing at the wrong time with the wrong person. It is exacerbated by poor preparation, poor choice of treatment and the patient, for that procedure. Loss of concentration and distraction will further compound the issue. Then, if you don’t stop immediately you will create an irretrievable situation from which you may not be able to correct the mistake. It has now become a problem and the patient may now be The Difficult Patient.
You have made a mistake. Stop. Acknowledge to yourself and with your patient. Explain what has happened and what the options are. Only then following agreement should you proceed with treatment. Informed Consent, and Contemporaneous Notes all in one. Was this a Patient or treatment that you should have referred. Did you complete your Due Diligence?
I continually look back, at how many of both I have had to deal with. When you get them together i.e., a mistake and a difficult patient, then you need to be very well prepared. Thankfully I have survived.
THE PATIENT
We have to be able to assess those who come to us for care. Many personality types with multiple traits abound, some of who may not be ideal for your own personality type. The ability to recognise that a particular person may not empathize with you, or that you may not be the person to treat this patient, is a skill you must learn. Can you understand potential difficulties you might have with your own personality and that of the patient? Add to that, unrealistic expectations. I know we don’t graduate with a degree in psychology, so I would suggest looking into various psychological profiles by which you can make a reasonable assessment of the person you are going to have to deal with. It is important that we do not create a Difficult Patient by our actions or omissions.
You can either adapt yourself and your team and accept whatever happens or you refer.
REFERRAL
It is not just the tooth you are going to treat. Do you have the skill set to carry out a particular treatment with a difficult patient? By making a decision to refer your patient and/or the treatment, may be to everybody’s advantage. By explaining everything with your patient they will respect you and get the treatment they need. You are in control.
CONTEMPORANEOUS NOTES
How and who records them? How do you analyse them? Do you go through all stages of the treatment proposed to see where there may be potential complications? Remember the patient is always right even if! However, if you have a true record it will often prevent, deflect or even remove a conflict, or disagreement. Remember the treatment you carry out might appear routine and simple to us, but our patients often have totally different views of what we do, or think what we have done!
FRONT DESK PROTOCOL AND COMPLAINTS
Your staff who help you today as part of the team, must be educated and supported to deal with issues of disagreement or personality conflict. Then, when issues do happen, they are going to be able to deal with, and maybe even deflect the complaint, and not allow it to be compounded or exaggerated.
Check that the protocols you have are fit for purpose to deal with a complaint, a simple event, a potential mistake, but hopefully not conflict. Do we cause our patients to become difficult?
ARE YOU PREPARED
A difficult patient, a mistake, a difference of opinion can, and will happen at the wrong time. It is up to yourself to make sure it is always at the right time. By having all the protocols in place and being aware, sympathetic (with yourself as well) and reviewing them, and your notes continually, your patient may view you, as the not so difficult dentist.
Angus P Roche PositivePractice.ie
INSPIRED BY LIFE IN DENTISTRY JULY 2020
HIGHLY CONFIDENTIAL PRIVATE AND WITHOUT PREJUDICE