Four Ways to Avoid Trouble

Back in 2004 I was recruited as a Lay Member of the General Dental Council Fitness to Practise Panel (FtPP). I’d spent most of my life as an actor and musician and remarkably little of it in the dental surgery. Unlike those of you who work in a regulated, healthcare role, artists don’t have to worry about patient safety or the reputation of an entire profession. Although I and my fellow performers were expected to behave ‘professionally’, there was little at stake for us if we didn’t. In fact having a criminal record or indulging in wild behaviour has enhanced many an actor’s career instead of ending it.

Having been thrown in at the deep end of dentistry, I have since had 10 years immersion in what can happen when a dentist or DCP is called to account because of a complaint. I have sat on more than 150 cases covering a huge range of alleged acts of misconduct. I had expected to be considering issues around clinical competence but I soon realised that the root cause of any trouble was almost always behavioural. You only need to look at the summaries at the back of the GDC Gazette to see the variety of issues and outcomes. The background to these cases is often poignant and very human.

After all that I have seen in my years as a FtP lay member, I wouldn’t wish anyone to end up in front of a GDC panel. Whatever the outcome of a case, and many respondents walk away with no allegations being found proved, it is a stressful and distressing experience for you, your colleagues and your family. Reading this, you may admit to an uneasy -­‐ and resentful -­‐ dread that you could end up in that position through no fault of your own. Even if you know you have done nothing unprofessional, you may think about the risk  to your reputation, your business, your team and most importantly to your patients’ confidence in you. I want to share with you some strategies to help you take control of your fate and make sure that this doesn’t happen to you.

I believe, based on my experience, that if you always follow the GDC Standards Principle 1 and put the patient first then you should never get  into trouble. That sounds so simple. So what gets in the way? I’ve identified 4 main themes.

1: Vanity

Pride in one’s work is admirable but vanity is not. It is essentially selfish and makes us a bit blind, a bit deaf and a bit stupid. It means that you are the most important person in the room, not the patient. Examples of this include not listening to the advice of a colleague, dismissing the concerns of a patient or allowing yourself to become isolated and out of touch with new developments in dentistry. Once complacency sets in, things can, and often do, go wrong. Of course, we all make mistakes but it is what you do next that matters. Francis Report from 2013 recognises that heath professionals have a ‘duty of candour’. You can disarm almost any situation by being honest, open and transparent. Be seen to be modest, to be reflecting upon the choices you make and to take responsibility. If you don’t, it creates a bigger problem.

2: Insight

Do you have any blind spots about your skills and behaviour? Most of us do. Ignore these at your peril. There is too much at stake. As a health care professional, it is your public duty to make sure you know your own strengths and weaknesses. You can build your self-­‐awareness by asking colleagues and patients for feedback, by making sure that you are up-­‐to-­‐date with new developments and most importantly, by reflecting on how you  have handled things, by sharing your doubts and asking questions. This builds trust. It shows that you are a professional with integrity who puts the patient first.

3: Consent.

Many allegations revolve around whether a patient has given informed consent. I strongly suggest you make the consent process memorable for the patient so that they will take responsibility for their decision. Remember you are the expert and they are the vulnerable ones. You only make yourself vulnerable if you don’t take this seriously enough.

4: Common Sense:

The guidance tells us that if you deviate from established practice and guidance, you should record the reasons why in order to be able to justify your decision. If you have a sound, ethical reason for your clinical choice to treat or not to treat a patient, then have faith in that and be transparent. If there is any risk of a misunderstanding of your motives, make sure you write everything down. This is just common sense. You could ask a colleague for advice, refer to the GDC standards, speak to your indemnity provider and then write down what you found out. Be transparent with the patient about your concerns and make sure that you share with them all the facts they need to make a decision. If you promote a treatment that happens to be more profitable for you, be clear with yourself, the patient and in your notes that it really is the best option for that patient.

Public confidence in a profession can be easily dented. After ten years on the panel I can see clearly that by putting the patient first without fail, you will build trust, improve your reputation and that of your profession, build  patient loyalty, create a thriving business and have a clear conscience.