Call log

These cases are based on actual calls made to MDDUS advisers and are published here to highlight common challenges in dental practice. Details have been changed to maintain confidentiality.

CCTV with audio

Q. We have a couple of CCTV cameras in our reception area to review patient interactions with the practice team. We had an incident with an aggressive patient yesterday and I wondered if we could add a microphone to pick up audio as well as video. Would this be possible if we put up plenty of signs to inform patients in advance?

Before installing any audio recording devices in your reception area, you would have to be sure that patient confidentiality could be protected at all times. Patients would have to be fully informed of this change, with notices at routine touchpoints such as the practice website or leaflets, social channels, or posters in the waiting room. You would also have to give staff sufficient training to ensure they do not discuss confidential clinical information at the reception desk. You may have to consider providing a separate private space, away from the CCTV system, for any patients who wish to speak about confidential matters. Should confidential information be picked up by a CCTV audio recording, this would lead to significant data protection issues around retention, storage and protection from unauthorised access, similar to those involved in recording patient telephone calls.

Digital signatures

Q. The practice is trying to cut down its use of paper. Are we allowed to ask patients to sign their medical history forms digitally, or must this be done in person?

It is perfectly acceptable for patients to sign their medical history digitally – this has become more popular since the pandemic. But the patient must use a signature and not a typed name. The practice may wish to look into a system such as Clinipad, or similar, which allows signatures to be verified as original and unaltered. If the records are requested, the form must be reproducible with the signature clearly visible.

Chaperone for aesthetics

Q. The practice is quite short staffed at the moment and I wondered if we needed a chaperone, such as a dental nurse, to be present during aesthetic consultations and facial aesthetic treatments?

The General Dental Council expects dentists to apply the same standard of care to patients irrespective of the type of treatment they are undergoing. This means the regulator’s Standards guidance (specifically at 6.2.2) applies to facial aesthetics as it does to all other dental treatments. It clearly states that “you should work with another appropriately trained member of the dental team at all times when treating patients in a dental setting”, unless there are exceptional circumstances. “Exceptional circumstances” are unavoidable circumstances which are not routine and could not have been foreseen. Absences due to leave or training are not exceptional circumstances. Remember also that it is not impossible for a patient to have an anaphylactic reaction to some components of facial aesthetics, and that medical emergencies can occur at any time.

Suspicious police request

Q. We’ve received an email that appears to be from a police officer, requesting access to a patient’s dental records in relation to a serious assault investigation. It has a signed mandate attached, but there is a discrepancy between the email and the mandate in terms of the patient’s date of birth. I’m worried the email is not genuine. Should I respond?

It is a concern to see an error in a key piece of information such as date of birth and so it would not be appropriate to release the patient’s records without first confirming the request is valid. It may be advisable to contact the police force separately, obtaining contact details via their website. You could then verify with them the name of the officer who has made the request. It may also be worth contacting the patient directly to ask if she did in fact sign this mandate, and confirm she is happy to release her records.

Consent language barrier

Q. A lot of our dental patients are native Polish speakers, with many understanding only a handful of basic English words. The treatment consent form we ask them to sign is in English. While I take the time to fully explain the content of the form (I speak fluent Polish and English), I’m worried that some of the dentists may not do so, leaving us legally vulnerable. Could we instead draft a certified Polish version of the form for the patients to sign?

When treating any non-English speaking patient in NHS practice, it is good practice to provide an interpreter, as reflected in the GDC Standards guidance (at 2.3.3). You should then ensure you accurately document the discussion in the notes. If your nurse/chaperone does not speak the language in question, then they are essentially only witness to the physical behaviour that occurs rather than any verbal discussions/consenting process. If a patient signs a consent form that they do not fully understand, then their signature is meaningless. It is the discussions that take place with the patient that determine whether the consent is valid. If you were to consider using Polish-language consent forms, these would have to be formally validated to ensure they would stand up to any future legal scrutiny. Another option may be to produce dual-language consent forms. Regardless, a failure to secure valid consent opens a dentist up to serious professional risk as well as risking patient harm.

WhatsApp with patients

Q. I’m looking to improve communication with my patients and I’m considering giving some of them a mobile number so they can contact me via WhatsApp (during office hours) in case they can’t get through on the main practice phone line. It would be a dedicated mobile phone, rather than a personal device. Is this ok?

MDDUS would advise you proceed with extreme caution with this plan. It is generally advised that patients are encouraged to use official points of contact, such as the practice telephone number or practice email address. Professional boundaries can become blurred when using more informal channels such as text messaging (even if a dedicated business phone is being used). It is also an approach that could leave you open to criticism in the event of any formal complaint or regulatory investigations. Read more in this MDDUS advice article.