Is it okay to say sorry – for instance in the case of a broken root tip?
Yes it is – you can apologise. An apology is not an admission of guilt. An apology at the right time early on will actually go a long way with placating the situation – so we actually recommend an apology. Of course, the apology must be worded carefully- for instance – “I’m sorry that things haven’t turned out as planned – but this is what we are going to do now”.
If you do a full pre-mortem assessment of all the risks should you then share that with the patient as part of the informed consent process?
Whatever you say to the patient in a discussion should be documented. It depends – if you’re very adept with extractions and can remove those broken root tips – you may not need to discuss it with the patient – or if you can confidently remove the endodontic file. When I was a practicing dentist I used to say to patients “there’s a slight chance that this root might break and if that happens I can still get it out but with slightly more surgical procedure”. I used to like to advise them if it was going to be a simple extraction or if it was going to turn into a more difficult extraction. The more invasive the treatment the more comprehensive the pre-operative discussion should be.
If we call MIPS’ clinico-legal advice line can we ask to speak with Jeff?
Unfortunately not – but we do have a dental expert on staff during business hours. You are always welcome to call our 1800 number and get some advice from a specialist dental adviser. Outside of office hours you may speak to an adviser outside of the dental profession, however, the code of ethics is very similar in both disciplines and they would be able to guide you until we can get you in contact with a dentist.
Should you get the patient to sign anything once we issue a refund?
Absolutely. MIPS has a form which basically says that they waive any future complaint or any future legal action. This form is available by contacting our clinico-legal advice team. The last thing you do is issue a refund without getting a signature from a patient. Before you give a refund you should consult MIPS. MIPS will often suggest a refund as a good way to stop the complaint from getting bigger.
Should you be disclosing the risk of very unlikely circumstance occurring? For instance the risk of breaking a needle when giving LA
• Short answer, probably no. You would need to know the statistical probability as well as the difficulty or ease of removing the fractured needle. • I understand such a fracture occurs when the needle section separates from the hub, and is easy to remove with tweezers if enough needle protrudes to grasp on. Good technique is paramount, never bury the needle, choose a long enough needle so at least 3-5mm is not buried in the soft tissues. Similar to forcibly syringing irrigant down a root in Endodontics, good technique will never result in a problem. • We suggest you consult this online article for further information about informed consent: https://www.mips.com.au/Articles/informed-consent
Are there forms from MIPS (or anywhere) that have a list of risks to provide to the patient to make sure we disclose everything?
We have to remember with pre-printed forms that just because the patient signs it – it doesn’t necessarily mean that the patient understands everything. If you are relying on a form to prove that you’ve got consent – it doesn’t really do that. If you have a pre-printed form or brochure – the best way to get consent is to handwrite over it to prove what has been discussed with the patient.
What is the clinico-legal advice regarding Botox injections?
• Just remember your scope of practice. When you’re sticking needles into extra-oral sights there’s lots of nerve structures. You must have appropriate qualifications and training and will likely need an extension on your indemnity cover, such as MIPS’ endorsement for ‘minor cosmetics’. • From MIPS’ perspective it’s important to note that if you haven’t advised us of a change of scope of practice and your starting to provide Botox injections – it makes it very difficult to cover something that may go wrong. • Patients tend to have higher expectations for anything cosmetic, so it is worthwhile taking the time to explain the variations in the outcome to patient beforehand to reduce the risk of a complaint after the procedure.
When you place a crown to a vital tooth and the patient ends up needing root canal treatment, should the dentist be prepared to pay for the root canal therapy?
• Ultimately, it’s between you and your patient. I often spell it out to the patient – I’ll tell them that I’m worried about the tooth losing vitality after the procedure. • I think it’s quite valid to say to the patient that if the complication happens – then you are responsible for the cost.
What is the medico-legal advice for a dentist doing orthodontic treatments?
I see a lot of general dentists who have complaints from the public about their orthodontics. If you are a general dentist performing orthodontics I would suggest that you say to the patient or the patient’s parents before treatment that they could see an orthodontic specialist. It would also be a safe practice to establish a good relationship with an orthodontic practice if something goes wrong and you need assistance. Once again, ensure you only practice within the scope of your training, qualifications and experience.
What was your biggest mistake in your dental career and how did you manage it?
The broken file was the biggest problem that I faced. It happened a lot – and the first two times that it happened I referred to the endodontist – I paid for the treatment, paid for the crown, but the patient was still very angry though.