Scenario: Questionable Competency

Remember to consider general issues as well as GDC/CQC standards:

• Put patient’s best interests and safety first (GDC Standard 1) – Complications are occurring with patients – these need resolving first.
• Communicate effectively with patients (GDC Standard 2) – Careful communication with the patients is necessary to resolve the situation.
• Obtain valid consent (GDC Standard 3) – Was valid consent, with appropriate risks, recorded?
• Complaints procedures and handling (GDC Standard 5) – Patients may want to complain as they will have paid significant amounts for the implants.
• Maintain, develop and work within professional skills and knowledge (GDC Standard 7) – A thorough reflection on your own skills and dental competence.
• Clinical governance – Is an audit of complications required?
• Referrals – The patients may require referral to specialists to manage complications.

You short-term management is about patient safety and mediating the initial situation:

• Document and assess complications – were these complications due to practitioner error or could they attributed to patient factors e.g. smoking. Was valid consent obtained? Document concerns, thorough histories and complications.
• Apologise to the patients and reassure them – an immediate apology will diffuse tension. Reassure the patient that you will manage their concern as best as possible.
• Provide acute/emergency management – make sure the patient is stable and out of any acute concerns before you send them away.
• Refer to the complaints procedure – if the patient is unhappy then you may have to direct them to the complaints procedure. Settling these in-house would be ideal.
• Discuss cases with a colleague/supervisor – is there something you are overlooking? A colleague may be more experienced in this area than you and may provide advice on how to deal with the complications.
• Discuss with your indemnity provider – they may provide you with advice on how to manage these patients and minimise risks of complaints escalating. In this situation, it may be important to make them aware early on.
• Document complete, concise, clear and contemporaneous notes – especially in a situation of complaint, thorough documentation is very important.

• Audit the complications and patients – go back through the patient notes and assess why complications may have occurred. Compare practice to standards set out by groups such as the Association of Dental Implantology. This will help identify if these are recognised risks or potential clinical incompetence.
• Recall any required patients and offer management – recall any patients who may have been effected by poor treatment. You need to arrange appropriate management. You may need to accept covering patient costs for any treatment they require to correct problems.
• Refer to a colleague – if necessary, refer patients to a colleague or a specialist to provide the further treatment.
• Handle complaints – handle any complaints in accordance with practice and GDC policy. Involve indemnity providers if needed.
• Reflection and portfolio – your dental competence may be questioned in this scenario. Reflecting on your practice will be important and seeing what you could have done differently.
• CPD – it would be worth attending further courses to improve your skills and stopping this procedure whilst you feel you lack dental competence. Patient safety is paramount.
• Team meetings – this may be a good opportunity to discuss complaints handling etc with the rest of the team in a meeting.