First-time risks of dental practice

WHATEVER the outlook of a dentist entering general practice for the first time, there are clearly both risks and benefits associated with taking this step.

Any sensible risk management strategy starts by trying to identify the potential risks involved in the activity. Experience and case studies suggest some recurring risk themes for those new to practice, often relating to:

• unfamiliarity with NHS regulations
• communication
• knowing your limits.

These factors can interact to multiply the risks involved. Imagine, for example, a scenario where a patient requires removal of an impacted lower third molar. The VDP correctly identifies the indications for removal and explains the procedure and risks to the patient who verbally consents. However, the trainee is unaware of the fees involved and does not provide a written estimate. What if they also decide that verbal consent seems clear enough and do not obtain written consent specifying the associated risks? What if they have not discussed the procedure with their nurse beforehand and are unaware that the nurse has no surgical experience? What if they then decide to go ahead and remove the tooth because, after all, they have 30 minutes free until their next patient arrives and they have assisted with a few cases like this as a student?

There are numerous strategies available to minimise the chances of this kind of nightmarish situation and they largely relate to the bullet points above.

Firstly, I would encourage new dentists to study the Statement of Dental Remuneration (SDR) until they are fully conversant with its Byzantine details. I advise this with a heavy heart as it is never something I have read myself with any degree of enjoyment. I have, however, appreciated the feeling of relaxation – while discussing treatment plans, estimates and the need for prior approval with patients – that comes from having put in the spade-work of learning the regulations. For those students who haven’t yet heard of the SDR – don’t worry – you will be introduced to its delights soon enough.

In my opinion, and admittedly it cannot be proved either way, the most effective way of staying out of trouble is through open and honest communication. Patients are human beings who quite reasonably want to know if there are different options for their treatment, what procedures are involved in providing it and how much it is going to cost. On this last point, when, during the VT year, patients are asked to assess how the VDP has communicated with them, one factor that often comes up is that they would rather be clearly told how much their treatment is likely to cost. So VDPs should make a point of giving cost estimates from day one as this could help significantly minimise complaints.

The importance of communicating clearly extends to interactions with colleagues and, for VDPs, the key players are the trainer and the nurse, as well as the VT adviser. All of these people are best regarded as colleagues as opposed to bosses. Each has their own perspective on the challenges VDPs face and can provide their own brand of advice and support on clinical and non-clinical matters. This support team is unique to the first year in general practice and so it is hugely important to take maximum benefit from it.

When it comes to knowing your limits, graduates entering general practice should consider the Dunning Kruger Effect (go look it up!). Put simply, this psychological phenomenon means that if you think you’re really, really good then you may well be a dumpling. (Think about some of the auditions on Britain’s Got Talent…) One strong countermeasure is to seek out and welcome feedback from others and there are plenty of opportunities for this during VT.

Similar risks exist for those entering associateships for the first time – and the solutions are also unsurprisingly similar. For example, dentists at this stage in their career may have had overly supportive training practices that sheltered them from the realities of NHS “paperwork” and so some revision here could be beneficial. Remember also that “independent practice” does not mean “alone” and it is important to keep communication and peerreview active within the practice as well as through CPD, memberships of societies and so on.

If all this talk of risks seems a bit daunting, bear in mind that figures show VDPs and dentists up to five years qualified are relatively low risk in terms of complaints and claims reaching the defence union. It is also reassuring to know that MDDUS is an excellent source of informal advice for managing any minor issues as they arise – and yes, I know that is true from personal experience and do not just say it here for diplomatic purposes.

In summary, dentists embarking on their adventures in general practice should be aware that they are relatively unlikely to encounter major problems. They should communicate openly with colleagues and patients, and should be aware of the many sources of support available to them. In other words, relax and enjoy it.

Billy Cameron is a dentist and VT adviser based in the west of Scotland