Scenario
A patient attends complaining of pain from an upper right tooth. On reading his records, you note that he has a carious UR7 which was due for treatment by your colleague. For some reason, the treatment was not completed and the patient was not provided any future appointments. Discuss how you would manage this case.

Take a few minutes to consider your answer to this and then compare to the suggested answers below.

Which issues/standards are involved?

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

  • Put patient’s best interests and safety first (GDC Standard 1) – the priority should be to find a solution for the current problem i.e. get the patient out of pain.
  • Communicate effectively with patients¬†(GDC Standard 2) – there are sensitive issues here so communicating effectively with the patient is vital.
  • Complaints procedures and handling (GDC Standard 5) – the patient may want to make a complaint if something has been missed, therefore it would be prudent to know the appropriate complaints procedures.
  • Raising concerns (GDC Standard 8) – there is a question of improper treatment and mismanagement – is there a potential to escalate your concerns?
  • Clinical competency¬†– if something has been mismanaged, is there need for further training and investigation?
  • Negligence¬†– there may be a case of negligence against your colleague.
  • Clinical governance – it may be wise to audit computer systems and records to ensure that this wasn’t an accident.

What is your short-term management?

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

  • Explain clearly the dental situation to the patient – the patient needs to be aware of their situation and what potential treatment options may be available.
  • Listen to any of the patient’s concerns and apologise if necessary – the patient may not be very happy that incomplete treatment was provided for this tooth. If you apologise, it does not put any blame on you but it may help calm the patient and remedy the situation.
  • Get the patient out of pain if possible – offer pain-relieving options to the patient. Ultimately that is why they have attended.
  • Arrange definitive management for the patient – they clearly have been missed from the patient diary for some reason – either offer to continue their incomplete treatment yourself or refer to the appropriate person.
  • Refer to complaints procedures if needed – the patient may want to complain about their treatment, therefore direct them to the appropriate avenues. Ideally, you want to solve any conflicts in-house before escalating elsewhere
  • Discuss with your supervisor/indemnity provider – if you feel further support is needed and you want a second opinion, discuss this with your supervisor. Your indemnity provider will help ascertain if you need to be concerned about any other issues with the colleague.
  • Document complete, concise, clear and contemporaneous notes – documentation is vital to demonstrate that you did everything correctly in case any complaints are brought forward.
What is your long-term management?
  • Discuss with colleague about the patient – either you or your supervisor should discuss the case with the other dentist to establish if this was an accident and a one-off – if this is the case then further exploration may not be needed.
  • Ensure appropriate patient follow-up and complaints handling – don’t forget about the patient who started off the scenario and their incomplete treatment! Ensure they are being treated as you planned.
  • Audit – if there is a concern that this is a repeated issue, then it may be useful auditing patients that this colleague has treated to assess if there are any problems with treatments and appointments. Assess if this practitioner has been negligent.
  • Team meetings – if this was an accident or there were concerns about things like complaints procedures, then this should be discussed with the entire team.
  • Raise concerns and escalate – if appropriate, your concerns should be raised in the appropriate manner. First locally, then regionally and area teams and if necessary, a fitness to practice case may be needed at the GDC.
  • Reflection and portfolio – reflect on the situation and record this in your portfolio to see what you have learnt from the situation.

Further information on dental core training applications can be found here.

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