Speaking out

WHEN it comes to the complex matter of raising concerns, the General Dental Council has a clear message for all dentists.

The regulator’s core guidance, Standards for the Dental Team, reminds us that we “must put patients’ interests first and act to protect them. If you fail to do so by not raising a concern, your own registration could be at risk.” Scary stuff indeed, but what does this really mean for the dental profession? What should you do if you feel a colleague is under-performing or has health issues that put the care of their patients at risk?

Most dental treatment is carried out to a good standard but we all have off days, don’t we? Perhaps it’s just me but, despite our best eff orts, not every treatment is perfect every time, not every root canal treatment is precisely at the apex and sometimes we break teeth during what should be a simple extraction.

Such mistakes tend to return to our surgery when we are given an opportunity to rectify any problems. These experiences often present a unique chance to identify areas of weakness in our knowledge and skills. And by refl ecting on our patient care we can use this knowledge to discuss difficult cases with our colleagues and also to inform our decisions on what CPD to do in the future.

Recognising problems

In real life, however, it’s sometimes hard to recognise our own failings. It’s a real effort to constantly keep an eye on our own performance and occasionally a head in the sand approach kicks in.

It’s easy to see how this approach could in time lead to a dentist underperforming. MDDUS has received many calls from members concerned about a colleague’s behaviour and the threat it poses to patient safety. Often they contact us after having noticed warning signs such as alcohol on their breath, signs of medication overuse (drowsiness or detachment), frequently arriving late to practice, lack of care with their appearance or taking too long to complete routine tasks.

It may be that a number of patient complaints have been made about the dentist, perhaps they haven’t completed part of their work or colleagues have found them unusually short-tempered or slow to respond to requests for assistance.

Stepping up

So what are you to do if you are working in a practice and you believe a colleague is providing substandard care? Where do your responsibilities lie? Should you send the GDC a dossier of your evidence at the first sign of a mistake? Or is there a better approach to take?

Clearly you are under an obligation to do something. Once you feel a colleague is struggling you just have to step up to the mark. Be in no doubt, this will not be easy. However, we are at our most professional when we support a colleague in need.

There are, of course, several ways of doing this and it’s up to you how you approach it. Firstly, ask yourself if you are considering the matter objectively and be sure your concerns are not infl uenced by other factors, such as your personal feelings towards the dentist. Remember the key consideration should be whether this dentist’s behaviour could risk patient safety.

You might consider taking time out to discuss the matter directly with your colleague. Over a coffee, lunch or even a pint at the end of the day are all possibilities but it’s a good idea to find a time and place where you won’t be disturbed and are not under any time pressure.

Your colleage may smell of alcohol or be frequently late

A quiet word is hopefully all that’s necessary: an indication that you’ve noticed they’re having difficulties and an offer of support and assistance might be very welcome. Hopefully that’s it, your colleague will admit they have problems and take the necessary steps to get the help they need. But often it’s much more difficult than that.

Your workmate might not be aware of any failings and feel you are over-stepping the mark in raising concerns about them. This can be particularly true if you, as a trainee, are raising an issue with a more senior team member (perhaps even your boss). This is where it is useful to discuss the matter with others in the practice to see if they share any of your concerns. A fellow associate, the hygienist or practice nurse can all be good allies. Keep the discussion focused on your specific concerns, what can be done to help and then perhaps consider approaching the dentist to discuss the matter as a group.

If that doesn’t work, give us a ring at MDDUS. By now you will need support and we can chat through other options that might include discussing things with a practice adviser or another experienced colleague. ultimately, it might be necessary in some cases to refer the matter to the GDC. Dentists must always bear in mind that the duty set out by the regulator to report serious concerns overrides any personal and professional loyalties.

Professional duty

There are, of course, many issues that might be causing problems for dentists. Health problems, addiction and stress cause misery to the one suff ering but have a huge impact on family life, colleagues and patients alike. Regardless of the reasons, our professional duty lies with patients and if they are at risk we must do all we can to prevent harm. This might mean having some diffi cult conversations with workmates and working with the practice team (and possibly the dentist’s family) to ensure they get the medical care they need.

Raising concerns and supporting each other are basic tenets of dental professionalism and it is vital action is taken in good faith and for the right reasons. And while protecting patient safety is crucial, we are unfortunately seeing an increasing number of immediate referrals to the GDC by “concerned colleagues” based on what appears to be little evidence. One can only hope that such concerns are not being infl uenced by other, more personal or cynical motivations.

If you find yourself in a situation where a colleague is struggling, feel free to give us a call. We are always happy to advise and support you and guide you through the various stages.

Claire Renton is a dental adviser at MDDUS